scholarly journals Minimally invasive Chevron-Akin osteotomy

2020 ◽  
Vol 14 (3) ◽  
pp. 264-268
Author(s):  
Gustavo Nunes ◽  
João Magalhães ◽  
Tiago Baumfeld ◽  
Roberto Pinto
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Case Series ◽  
Preoperative Assessment ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Intermetatarsal Angle ◽  
Akin Osteotomy ◽  
Severe Hallux Valgus

Objective: To present the clinical and radiographic results of surgical treatment of patients with moderate to severe hallux valgus (HV) by minimally invasive Chevron - Akin osteotomy (MICA). Methods: The case series comprises 25 patients (30 feet) with diagnoses of moderate to severe HV treated surgically with the MICA technique. All patients answered the American Orthopedic Foot and Ankle Score (AOFAS) and rated pain on visual analogue scale (VAS) at preoperative assessment and at the last follow-up consultation. Radiological assessment included measurement of the valgus angles of the hallux (HVA) and the 1st and 2nd ray intermetatarsal angle (IMA). Complications and satisfaction ratings were also documented. Results: Mean follow-up was 14.6 months. Mean AOFAS increased from 42.8 to 90 and VAS reduced from 8.6 to 1.7. Mean HVA reduced from 31.7o to 8.4o and IMA from 14o to 5o. All these improvements were statistically significant (p<0.001). The most common complication observed was discomfort caused by hardware, affecting five feet (16.6%). Two patients (6.6%) had transitory neurapraxia and one patient (3.3%) developed reflex sympathetic dystrophy. There were no cases of infection, relapse, pseudarthrosis, or malunion of osteotomies. Subjective satisfaction ratings classified 93.3% of results as good or excellent. Conclusion: Minimally invasive Chevron-Akin osteotomy is a safe and reproducible technique that achieves good clinical and radiographic results for treatment of moderate to severe hallux valgus. Level of Evidence IV; Therapeutic Studies; Case Series.

Radiographic and Clinical Results of Minimally Invasive Chevron Akin Osteotomy for Moderate to Severe Hallux Valgus Deformities

2021 ◽  
pp. 193864002110459
Author(s):  
Toshinori Kurashige
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Inclination Angle ◽  
Case Series ◽  
Metatarsal Head ◽  
Clinical Results ◽  
Level Of Evidence ◽  
First Metatarsal ◽  
Akin Osteotomy ◽  
Severe Hallux Valgus

Background: Few studies have reported results of minimally invasive chevron Akin osteotomy (MICA) for moderate to severe hallux valgus correction. This study aims to evaluate MICA for moderate to severe hallux valgus radiographically and clinically. Methods: Forty feet were prospectively reviewed. Twenty-eight feet (70%) had a severe deformity (hallux valgus angle (HVA) ≥40° and/or first intermetatarsal angle (IMA) ≥18°). We measured HVA, IMA, lateral shape of the metatarsal head (round sign), tibial sesamoid position, first metatarsal shortening on anteroposterior weightbearing radiographs, and inclination angle of first metatarsal on lateral weightbearing radiographs. We evaluated the Japanese Society for Surgery of the Foot hallux scale and Self-Administered Foot Evaluation Questionnaire responses preoperatively and at the most recent follow-up. Results: All measurements except shortening and inclination angle improved significantly. Both clinical scale and all subscores significantly improved. Conclusions: MICA improved moderate to severe hallux valgus both radiographically and clinically. Level of Evidence: Level IV: case series

Multicenter Early Radiographic Outcomes of Triplanar Tarsometatarsal Arthrodesis With Early Weightbearing

2019 ◽  
Vol 40 (8) ◽  
pp. 955-960 ◽  
Author(s):  
Justin J. Ray ◽  
Jennifer Koay ◽  
Paul D. Dayton ◽  
Daniel J. Hatch ◽  
Bret Smith ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Retrospective Case ◽  
Recurrence Rates ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Valgus Angle ◽  
First Ray ◽  
Akin Osteotomy

Background:Hallux valgus is a multiplanar deformity of the first ray. Traditional correction methods prioritize the transverse plane, a potential factor resulting in high recurrence rates. Triplanar first tarsometatarsal (TMT) arthrodesis uses a multiplanar approach to correct hallux valgus in all 3 anatomical planes at the apex of the deformity. The purpose of this study was to investigate early radiographic outcomes and complications of triplanar first TMT arthrodesis with early weightbearing.Methods:Radiographs and charts were retrospectively reviewed for 57 patients (62 feet) aged 39.7 ± 18.9 years undergoing triplanar first TMT arthrodesis at 4 institutions between 2015 and 2017. Patients were allowed early full weightbearing in a boot walker. Postoperative radiographs were compared with preoperative radiographs for hallux valgus angle (HVA), intermetatarsal angle (IMA), tibial sesamoid position (TSP), and lateral round sign. Any complications were recorded.Results:Radiographic results demonstrated significant improvements in IMA (13.6 ± 2.7 degrees to 6.6 ± 1.9 degrees), HVA (24.2 ± 9.3 degrees to 9.7 ± 5.1 degrees), and TSP (5.0 ± 1.3 to 1.9 ± 0.9) from preoperative to final follow-up ( P < .001). Lateral round sign was present in 2 of 62 feet (3.2%) at final follow-up compared with 52 of 62 feet (83.9%) preoperatively. At final follow-up, recurrence was 3.2% (2/62 feet), and the symptomatic nonunion rate was 1.6% (1/62 feet). Two patients required hardware removal, and 2 patients required additional Akin osteotomy.Conclusion:Early radiographic outcomes of triplanar first TMT arthrodesis with early weightbearing were promising with low recurrence rates and maintenance of correction.Level of Evidence:Level IV, retrospective case series.

Correction of Hallux Valgus Interphalangeus With an Osteotomy of the Distal End of the Proximal Phalanx (Distal Akin Osteotomy)

2016 ◽  
Vol 38 (2) ◽  
pp. 153-158 ◽  
Author(s):  
Robert Vander Griend
Keyword(s):  
Hallux Valgus ◽  
Proximal Phalanx ◽  
Case Series ◽  
Wedge Osteotomy ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Intraoperative Complication ◽  
Hallux Valgus Interphalangeus ◽  
Akin Osteotomy

Background: Operative correction of a symptomatic hallux valgus interphalangeus (HVI) deformity is often achieved with an osteotomy at the proximal end of the proximal phalanx (Akin osteotomy). However, the apex of the typical HVI deformity (center of rotation angle) is at the interphalangeal joint of the hallux. This study was done to evaluate the results of performing a medial closing wedge osteotomy at the distal end of the proximal phalanx. Methods: Thirty-three patients (33 feet) underwent an osteotomy at the distal end of the proximal phalanx for correction of HVI. All of the patients had other forefoot deformities which were corrected at the same time. Eight of these were revision procedures of prior forefoot operations. The length of follow-up was determined by the associated procedures with a minimum follow-up of 4 months. Results: The preoperative hallux valgus interphalangeus angle averaged 16 degrees of valgus (range 7-32 degrees) and was corrected to an average of 2 degrees of valgus (range 5 degrees valgus to 5 degrees varus). All of the patients were satisfied with the postoperative appearance and function of the first toe. Because of simultaneous correction of numerous other forefoot problems, it was not possible to specifically isolate or evaluate the effects and benefits of this osteotomy using outcomes measures. There was one intraoperative complication resulting in a fracture extending into the adjacent IP joint. Conclusions: Correction of an HVI deformity can be achieved with an osteotomy at the distal end of the proximal phalanx. This was a safe technique with few complications and with good results in terms of both correction and patient satisfaction. Level of Evidence: Level IV, retrospective case series.

scholarly journals Minimally invasive chevron/akin osteotomy: radiographic outcomes

2021 ◽  
Vol 15 (2) ◽  
pp. 110-114
Author(s):  
Kepler Alencar Mendes de Carvalho ◽  
Fernando Garnica Torrico ◽  
David Satiro Borges Pereira de Oliveira ◽  
André Donato Baptista
Keyword(s):  
Retrospective Study ◽  
Minimally Invasive ◽  
Hallux Valgus ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Statistical Relevance ◽  
Akin Osteotomy ◽  
The Mean

Objective: To evaluate radiographic outcomes in patients undergoing minimally invasive Chevron/Akin osteotomy (MICA) for hallux valgus correction. Methods: We have treated 31 patients (40 feet). Preoperative and postoperative hallux metatarsophalangeal angles (hallux valgus angles, HVA), intermetatarsal angles (IMA) between the first and second metatarsals, and distal metatarsal articular angles (DMAA) were followed up for 12 months. Results: The mean age of the patients was 53.2 years. Mean preoperative HVA, IMA, and DMAA values were 28.85°, 15.38°, and 14.35°, respectively. The mean postoperative angles measured after 1 year were 10.60°, 7.95°, and 7.48°. Improvements in HVA, IMA, and DMAA values showed statistical relevance. There were no losses in angular parameters during follow-up. Conclusion: The radiographic outcomes in patients undergoing MICA osteotomy for hallux valgus correction followed up for 12 months showed significant improvements and no recurrence of the deformity. Our results suggest that this technique is effective for correcting hallux valgus. Level of Evidence III; Therapeutic Studies; Comparative Retrospective Study.

scholarly journals Reverdin-Isham technique with and without fixation

2018 ◽  
Vol 12 (3) ◽  
Author(s):  
Aleksei Dickow Sato ◽  
Ronaldo Muramoto Nakato ◽  
Bruno Cerutti Bolsi ◽  
Thiago Pavani Zigovski ◽  
João Luiz Vieira da Silva
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Foot And Ankle ◽  
Aofas Score ◽  
Intermetatarsal Angle ◽  
Significant Difference ◽  
Proposed Modification ◽  
American Orthopaedic ◽  
Additional Fixation

Objective: This study evaluated the radiographic results of the traditional minimally invasive percutaneous Reverdin-Isham surgical technique for hallux valgus treatment using the American Orthopaedic Foot and Ankle Society (AOFAS) score and compared this result with a proposed modification involving additional osteosynthesis with a cannulated screw. Methods: We retrospectively assessed 22 feet across 15 patients with mild to moderate hallux valgus. All patients underwent surgical treatment using the Reverdin-Isham technique. Eleven feet were fixed with 2.4- or 2.7-mm cannulated screws. A single orthopaedic surgeon performed these procedures between January 2014 and June 2016. The metatarsophalangeal (MTP) angle and intermetatarsal angle (IMA) were evaluated using radiographs, and the AOFAS score was applied before surgery and 90 days after. Results: An improvement was found in the parameters evaluated in both groups, with significant differences shown between the pre- and post-procedure follow-up assessment. No significant difference was found between the groups with regard to fixation; however, the scores were slightly higher for the group where osteosynthesis was used. Conclusions: The Reverdin-Isham procedure is effective and safe for correcting mild to moderate hallux valgus and additional fixation presented with promising results, although without significant difference. Additional studies with larger samples and longer follow-up times are needed to define the role that additional screw fixation plays in the overall scope of treatment.Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Clinical and radiological outcomes of the first metatarsophalangeal arthrodesis with Kirschner wires for the treatment of severe hallux valgus

2020 ◽  
Vol 14 (1) ◽  
pp. 24-28
Author(s):  
Luiza Horta Barbosa ◽  
José Antônio Veiga Sanhudo
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Substantial Improvement ◽  
High Rate ◽  
Preoperative Period ◽  
Kirschner Wires ◽  
Level Of Evidence ◽  
Total Satisfaction ◽  
Severe Hallux Valgus

Objective: To present the clinical and radiographic outcomes of metatarsophalangeal arthrodesis of the hallux with crossed Kirschner wires and cerclage for the treatment of severe hallux valgus. Methods: Twenty-nine feet of 21 consecutive patients who underwent metatarsophalangeal arthrodesis to correct severe hallux valgus between March 2011 and April 2018 were clinically and radiographically evaluated. Results: After an average follow-up period of 42 months, 17 feet (58.6%) generated a response of total satisfaction with the procedure and 12 (41.4%) a response of satisfied with reservations; none of the patients were dissatisfied. Pain assessed using the visual analog scale improved from a mean of 8 before the procedure to 1.2 at follow-up. The American Orthopaedic Foot and Ankle Society score improved from a mean of 26.5 points before the procedure to 78 points at follow-up. The hallux valgus angle improved from a mean of 38.5° in the preoperative period to 13.1° at follow-up, i.e., an improvement of 25.4°. The intermetatarsal angle improved from a mean of 18.8° in the preoperative period to 15° at follow-up. Consolidation of arthrodesis occurred in all cases, but reintervention was required to remove the hardware in 17 operated feet (58.6%). Conclusion: Metatarsophalangeal arthrodesis with crossed Kirschner wires and cerclage for the treatment of severe hallux valgus produced high rates of satisfaction, with substantial improvement in pain and functional parameters, consolidation in all cases and excellent radiological correction, but had the drawback high rate of reintervention for hardware removal. Level of Evidence IV; Therapeutic Study; Case Series.

scholarly journals Lateral open wedge calcaneus osteotomy with bony allograft augmentation in adult acquired flatfoot deformity. Clinical and radiological results

2021 ◽  
Author(s):  
Gabriele Colo’ ◽  
Mattia Alessio Mazzola ◽  
Giulio Pilone ◽  
Giacomo Dagnino ◽  
Lamberto Felli
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Deformity Correction ◽  
Tibialis Posterior ◽  
Open Wedge ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Adult Acquired Flatfoot Deformity

Abstract The aim of this study is to evaluate the results of patients underwent lateral open wedge calcaneus osteotomy with bony allograft augmentation combined with tibialis posterior and tibialis anterior tenodesis. Twenty-two patients underwent adult-acquired flatfoot deformity were retrospectively evaluated with a minimum 2-year follow-up. Radiographic preoperative and final comparison of tibio-calcaneal angle, talo–first metatarsal and calcaneal pitch angles have been performed. The Visual Analog Scale, American Orthopedic Foot and Ankle Score, the Foot and Ankle Disability Index and the Foot and Ankle Ability Measure were used for subjective and functional assessment. The instrumental range of motion has been also assessed at latest follow-up evaluation and compared with preoperative value. There was a significant improvement of final mean values of clinical scores (p < 0.001). Nineteen out of 22 (86.4%) patients resulted very satisfied or satisfied for the clinical result. There was a significant improvement of the radiographic parameters (p < 0.001). There were no differences between preoperative and final values of range of motion. One failure occurred 7 years after surgery. Adult-acquired flatfoot deformity correction demonstrated good mid-term results and low recurrence and complications rate. Level of evidence Level 4, retrospective case series.

Loss of Correction After Chevron Osteotomy for Hallux Valgus as a Function of Preoperative Deformity

2018 ◽  
Vol 40 (3) ◽  
pp. 287-296 ◽  
Author(s):  
Gerhard Kaufmann ◽  
Stefanie Sinz ◽  
Johannes M. Giesinger ◽  
Matthias Braito ◽  
Rainer Biedermann ◽  
...  
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
X Rays ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Loss Of Correction ◽  
Chevron Osteotomy ◽  
Significant Correction ◽  
Preoperative Deformity

Background: Recurrence is relatively common after surgical correction of hallux valgus. Multiple factors are discussed that could have an influence in the loss of correction. The aim of this study was to determine preoperative radiological factors with an influence on loss of correction after distal chevron osteotomy for hallux valgus. Methods: Five hundred twenty-four patients who underwent the correction of a hallux valgus by means of distal chevron osteotomy at our institution between 2002 and 2012 were included. We assessed weightbearing x-rays at 4 time points: preoperatively, postoperatively, and after 6 weeks and 3 months. We investigated the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), joint congruity, and the position of the sesamoids. Results: At all points of the survey, significant correction of the IMA and HVA was detected. The IMA improved from 12.9 (± 2.8) to 4.5 (± 2.4) degrees and the HVA from 27.5 (± 6.9) to 9.1 (± 5.3) degrees. Loss of correction was found in both HVA and IMA during follow-up with a mean of 4.5 and 1.9 degrees, respectively. Loss of correction showed a linear correlation with preoperative IMA and HVA, and a correlation between preoperative DMAA and sesamoid position. Conclusion: The chevron osteotomy showed significant correction for HVA, IMA, and DMAA. Preoperative deformity, in terms of IMA, HVA, DMAA, and sesamoid position, correlated with the loss of correction and could be assessed preoperatively for HVA and IMA. Loss of correction at 3 months persisted during the follow-up period. Level of Evidence: Level IV, retrospective case series.

scholarly journals Proximal Rotational Metatarsal Osteotomy for Hallux Valgus (PROMO)

2018 ◽  
Vol 3 (3) ◽  
pp. 247301141879007 ◽  
Author(s):  
Pablo Wagner ◽  
Emilio Wagner
Keyword(s):  
Hallux Valgus ◽  
Case Series ◽  
Valgus Deformity ◽  
Metatarsal Osteotomy ◽  
Level Of Evidence ◽  
Reliable Technique ◽  
Intermetatarsal Angle ◽  
Hallux Valgus Deformity ◽  
The Mean ◽  
Prospective Case Series

Background: Hallux valgus deformity consists of a lateral deviation of the great toe, metatarsus varus, and pronation of the first metatarsal. Most osteotomies only correct varus, but not the pronation of the metatarsal. Persistent postoperative pronation has been shown to increase deformity recurrence and have worse functional outcomes. The proximal rotational metatarsal osteotomy (PROMO) technique reliably corrects pronation and varus through a stable osteotomy, avoiding fusing any healthy joints. The objective of this research is to show a prospective series of the PROMO technique. Methods: Twenty-five patients (30 feet) were operated with the PROMO technique. The sample included 22 women and 3 men, average age 46 years (range 22-59), for a mean prospective follow-up of 1 year (range 9-14 months). Inclusion criteria included symptomatic hallux valgus deformities, absence of severe joint arthritis, or inflammatory arthropathies, with a metatarsal malrotation of 10 degrees or more, with no tarsometatarsal subluxation or arthritis on the anteroposterior or lateral foot radiograph views. The mean preoperative and postoperative Lower Extremity Functional Scale (LEFS) score, metatarsophalangeal angle, intermetatarsal angle, metatarsal malrotation, complications, satisfaction, and recurrence were recorded. Results: The mean preoperative and postoperative LEFS scores were 56 and 73. The median pre-/postoperative metatarsophalangeal angle was 32.5/4 degrees and the intermetatarsal angle 15.5/5 degrees. The metatarsal rotation was satisfactorily corrected in 24 of 25 patients. An Akin osteotomy was needed in 27 of 30 feet. All patients were satisfied with the surgery, and no recurrence or complications were found. Conclusions: PROMO is a reliable technique, with good short-term results in terms of angular correction, satisfaction, and recurrence. Long-term studies are needed to determine if a lower hallux recurrence rate occurs with the correction of metatarsal rotation in comparison with conventional osteotomies. Level of evidence: IV, prospective case series.

Does Transection of the Superficial MCL During HTO Result in Progressive Valgus Instability?

2021 ◽  
pp. 036354652110591
Author(s):  
Joo-Hwan Kim ◽  
Dong Jin Ryu ◽  
Sung-Sahn Lee ◽  
Seung Pil Jang ◽  
Jae Sung Park ◽  
...  
Keyword(s):  
Case Series ◽  
Preoperative Assessment ◽  
International Knee Documentation Committee ◽  
Clinical Results ◽  
Osteotomy Site ◽  
Tibial Osteotomy ◽  
Level Of Evidence ◽  
Valgus Stress ◽  
Valgus Instability

Background: During high tibial osteotomy (HTO), the superficial medial collateral ligament (sMCL) is cut or released at any degree to expose the osteotomy site and achieve the targeted alignment correction according to the surgeon’s preference. However, it is still unclear whether transection of sMCL increases valgus laxity. Purpose: We aimed to assess the outcomes and safety of sMCL transection, especially focusing on iatrogenic valgus instability. Study Design: Case series; Level of evidence, 4. Methods: Seventy-two patients (89 knees) who underwent medial open wedge HTO (MOWHTO) with transection of the sMCL between October 2013 and September 2018 were retrospectively investigated. Clinical evaluations, including the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Tegner and Lysholm scores, were performed preoperatively and at 2 years postoperatively. The radiographic parameters hip-knee-ankle (HKA) angle, joint line convergence angle on standing radiographs (standing JLCA), and weightbearing line (WBL) ratio were assessed preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. To evaluate valgus laxity, we assessed the valgus JLCA and medial joint opening (MJO) at the aforementioned time points using valgus stress radiographs. Results: All clinical results at the 2-year follow-up were significantly improved compared with those obtained at the preoperative assessment ( P < .001). The postoperative HKA angle significantly differed from the preoperative one, and no significant valgus progression was observed during follow-up (preoperative, 8.5°± 2.7°; 3 months, –3.5°± 2.0°; 6 months, –3.2°± 2.3°; 1 year, –3.1°± 2.3°; 2 years, –2.9°± 2.5°; P < .001) The mean WBL ratio was 62.5% ± 9.0% at 2 years postoperatively. The postoperative valgus JLCA at all follow-up points did not significantly change compared with the preoperative valgus JLCA (preoperative, –0.1°± 2.1°; 3 months, –0.2°± 2.4°; 6 months, –0.1°± 2.5°; 1 year, 0.1°± 2.5°; 2 years, 0.2°± 2.2°) The postoperative MJO at all follow-up points did not significantly change compared with the preoperative MJO (preoperative, 7.1 ± 1.7 mm; 3 months, 7.0 ± 1.7 mm; 6 months, 6.9 ± 1.9 mm; 1 year, 6.7 ± 1.8 mm; 2 years, 6.8 ± 1.8 mm). Conclusion: Transection of the sMCL during MOWHTO does not increase valgus laxity and could yield desirable clinical and radiographic results.

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