Cargando…

Percutaneous Chevron Osteotomy Combined with Adductor Tendon Release for Hallux Valgus Correction

CATEGORY: Bunion, Midfoot/Forefoot INTRODUCTION/PURPOSE: The use of minimally invasive techniques for hallux valgus may provide complete deformity correction with minor soft tissue damage, which reduces morbidity and shortens recovery. In this way, some open osteotomies were adapted to percutaneous...

Descripción completa

Detalles Bibliográficos
Autores principales: Carlucci, Sofia, Carrasco, Nelly, Santini-Araujo, Maria, Parise, Ana, Conti, Leonardo, Villena, Daniel, Dozo, Daniel, Sotelano, Pablo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8696731/
http://dx.doi.org/10.1177/2473011419S00130
_version_ 1784619881898967040
author Carlucci, Sofia
Carrasco, Nelly
Santini-Araujo, Maria
Parise, Ana
Conti, Leonardo
Villena, Daniel
Dozo, Daniel
Sotelano, Pablo
author_facet Carlucci, Sofia
Carrasco, Nelly
Santini-Araujo, Maria
Parise, Ana
Conti, Leonardo
Villena, Daniel
Dozo, Daniel
Sotelano, Pablo
author_sort Carlucci, Sofia
collection PubMed
description CATEGORY: Bunion, Midfoot/Forefoot INTRODUCTION/PURPOSE: The use of minimally invasive techniques for hallux valgus may provide complete deformity correction with minor soft tissue damage, which reduces morbidity and shortens recovery. In this way, some open osteotomies were adapted to percutaneous approaches, with good outcomes reported. The minimally invasive chevron-Akin (MICA) described by Vernois and Redfern in 2011, combines benefits of percutaneous approaches with a stable internal fixation. Since 2015 we have adapted this technique, by adding a percutaneous adductor tenotomy to dispense with the Akin osteotomy. The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a minimally invasive chevron osteotomy and a percutaneous adductor tendon release. METHODS: This was a prospective cohort study. A total of 38 feet with moderate hallux valgus underwent the procedure and were followed up for a minimum 12 months (SD 1.10). The median age was 58 years (IQR 52 - 65), 36 women and 2 men. Radiological parameters were compared at preoperatory and at the last follow-up and included: Hallux Valgus Angle (HVA), Inter- Metatarsal Angle (IMA), Distal Metatarsal Articular Angle (DMAA) and first metatarsal shortening. Time to consolidation was also assessed. For clinical evaluation the American Orthopaedic Foot & Ankle Society score (AOFAS) was evaluated. Complications during the follow up were reported. Patients in which another procedure in the hallux was performed, with previous surgeries or not completed 1 year follow-up were excluded. RESULTS: Radiologic postoperative parameters demonstrated to achieved correction. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and distal metatarsal articular angle. Shortening of the first metatarsus was a mean 7.02 mm (IQR 1.24 - 10,27). The mean AOFAS score increased from 58.23 (SD 9.02) pre-operatively to 97.15 (SD 4.72) post-operatively (p< 0.001). Complications reported were 2 superficial infections, 1 broken screw, 1 screw extraction. Five patients referred metatarsalgia after surgery and 1 presented a fourth metatarsal stress fracture. Only one patient presented lost of correction in the first postoperative week and needed a second surgery. CONCLUSION: Our series of hallux valgus correction with a minimally invasive chevron osteotomy combined with the adductor tendon release shows good clinical and radiological outcomes, and results are comparable to series with the additional Akin osteotomy. Comparative studies are needed for major evidence.
format Online
Article
Text
id pubmed-8696731
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-86967312022-01-28 Percutaneous Chevron Osteotomy Combined with Adductor Tendon Release for Hallux Valgus Correction Carlucci, Sofia Carrasco, Nelly Santini-Araujo, Maria Parise, Ana Conti, Leonardo Villena, Daniel Dozo, Daniel Sotelano, Pablo Foot Ankle Orthop Article CATEGORY: Bunion, Midfoot/Forefoot INTRODUCTION/PURPOSE: The use of minimally invasive techniques for hallux valgus may provide complete deformity correction with minor soft tissue damage, which reduces morbidity and shortens recovery. In this way, some open osteotomies were adapted to percutaneous approaches, with good outcomes reported. The minimally invasive chevron-Akin (MICA) described by Vernois and Redfern in 2011, combines benefits of percutaneous approaches with a stable internal fixation. Since 2015 we have adapted this technique, by adding a percutaneous adductor tenotomy to dispense with the Akin osteotomy. The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a minimally invasive chevron osteotomy and a percutaneous adductor tendon release. METHODS: This was a prospective cohort study. A total of 38 feet with moderate hallux valgus underwent the procedure and were followed up for a minimum 12 months (SD 1.10). The median age was 58 years (IQR 52 - 65), 36 women and 2 men. Radiological parameters were compared at preoperatory and at the last follow-up and included: Hallux Valgus Angle (HVA), Inter- Metatarsal Angle (IMA), Distal Metatarsal Articular Angle (DMAA) and first metatarsal shortening. Time to consolidation was also assessed. For clinical evaluation the American Orthopaedic Foot & Ankle Society score (AOFAS) was evaluated. Complications during the follow up were reported. Patients in which another procedure in the hallux was performed, with previous surgeries or not completed 1 year follow-up were excluded. RESULTS: Radiologic postoperative parameters demonstrated to achieved correction. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and distal metatarsal articular angle. Shortening of the first metatarsus was a mean 7.02 mm (IQR 1.24 - 10,27). The mean AOFAS score increased from 58.23 (SD 9.02) pre-operatively to 97.15 (SD 4.72) post-operatively (p< 0.001). Complications reported were 2 superficial infections, 1 broken screw, 1 screw extraction. Five patients referred metatarsalgia after surgery and 1 presented a fourth metatarsal stress fracture. Only one patient presented lost of correction in the first postoperative week and needed a second surgery. CONCLUSION: Our series of hallux valgus correction with a minimally invasive chevron osteotomy combined with the adductor tendon release shows good clinical and radiological outcomes, and results are comparable to series with the additional Akin osteotomy. Comparative studies are needed for major evidence. SAGE Publications 2019-10-28 /pmc/articles/PMC8696731/ http://dx.doi.org/10.1177/2473011419S00130 Text en © The Author(s) 2019 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Carlucci, Sofia
Carrasco, Nelly
Santini-Araujo, Maria
Parise, Ana
Conti, Leonardo
Villena, Daniel
Dozo, Daniel
Sotelano, Pablo
Percutaneous Chevron Osteotomy Combined with Adductor Tendon Release for Hallux Valgus Correction
title Percutaneous Chevron Osteotomy Combined with Adductor Tendon Release for Hallux Valgus Correction
title_full Percutaneous Chevron Osteotomy Combined with Adductor Tendon Release for Hallux Valgus Correction
title_fullStr Percutaneous Chevron Osteotomy Combined with Adductor Tendon Release for Hallux Valgus Correction
title_full_unstemmed Percutaneous Chevron Osteotomy Combined with Adductor Tendon Release for Hallux Valgus Correction
title_short Percutaneous Chevron Osteotomy Combined with Adductor Tendon Release for Hallux Valgus Correction
title_sort percutaneous chevron osteotomy combined with adductor tendon release for hallux valgus correction
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8696731/
http://dx.doi.org/10.1177/2473011419S00130
work_keys_str_mv AT carluccisofia percutaneouschevronosteotomycombinedwithadductortendonreleaseforhalluxvalguscorrection
AT carrasconelly percutaneouschevronosteotomycombinedwithadductortendonreleaseforhalluxvalguscorrection
AT santiniaraujomaria percutaneouschevronosteotomycombinedwithadductortendonreleaseforhalluxvalguscorrection
AT pariseana percutaneouschevronosteotomycombinedwithadductortendonreleaseforhalluxvalguscorrection
AT contileonardo percutaneouschevronosteotomycombinedwithadductortendonreleaseforhalluxvalguscorrection
AT villenadaniel percutaneouschevronosteotomycombinedwithadductortendonreleaseforhalluxvalguscorrection
AT dozodaniel percutaneouschevronosteotomycombinedwithadductortendonreleaseforhalluxvalguscorrection
AT sotelanopablo percutaneouschevronosteotomycombinedwithadductortendonreleaseforhalluxvalguscorrection