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Vaggi S, Vitali F, Zanirato A, Quarto E, Colò G, Formica M. Minimally invasive surgery in medial displacement calcaneal osteotomy for acquired flatfoot deformity: a systematic review of the literature. Arch Orthop Trauma Surg 2024; 144:1139-1147. [PMID: 38212588 DOI: 10.1007/s00402-023-05188-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Minimally invasive surgery (MIS) in medial displacement calcaneus osteotomy (MDCO) has been proposed for surgical correction of adult-acquired flat foot deformity (AAFD) to reduce complications of open approaches. The aim of our study is to systematically analyze complications and the clinical and radiological results of MIS- MDCO. METHODS A systematic review of the English literature was performed on 30th October 2023. Randomized controlled trials and non-randomized trials, cohort studies, case-control studies and case series concerning surgical correction of AAFD with MIS-MDCO and with at least 15 patients were included. Case reports, technical notes, animal or cadaveric studies were excluded. The quality and risk of bias of the studies included were evaluated using GRADE and MINORS systems. Complications rate, clinical and radiological results were inferred from the studies included. RESULTS Nine articles were included. A total of 501 cases treated with MIS-MDCO were analysed with a mean follow-up of 11.9 ± 5.1 months. The reported wound infection rate was about 3% and sural neuropathy was rated about 1%. Only 4% of the cases required removal of the screw for pain. In the comparative studies (MIS versus Open MDCO), comparable clinical results but with significant differences (P < 0.001) in infection rates (1% versus 14%) and sural neuropathy (2% versus 1%) were observed. CONCLUSION AAFD correction performed with MIS-MDCO, with the limitation of a poor quality and high risk of bias of the included studies, seems to provide good clinical results and high subjective satisfaction with a lower complication rate compared to open approach. Further high-quality long-term comparative studies could better clarify complications and clinical and radiological outcomes of the MIS technique in the treatment of AAFD. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- S Vaggi
- Dipartimento Di Scienze Chirurgiche E Diagnostiche Integrate, Università Degli Studi Di Genova - DISC, Viale Benedetto XV 6, 16132, Genova, GE, Italy
- Clinica Ortopedica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy
| | - F Vitali
- Dipartimento Di Scienze Chirurgiche E Diagnostiche Integrate, Università Degli Studi Di Genova - DISC, Viale Benedetto XV 6, 16132, Genova, GE, Italy
- Clinica Ortopedica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy
| | - A Zanirato
- Dipartimento Di Scienze Chirurgiche E Diagnostiche Integrate, Università Degli Studi Di Genova - DISC, Viale Benedetto XV 6, 16132, Genova, GE, Italy.
- Clinica Ortopedica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy.
| | - E Quarto
- Clinica Ortopedica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy
| | - G Colò
- Orthopaedics and Traumatology Unit, SS Antonio and Biagio and Cesare Arrigo Hospital, 15121, Alessandria, Italy
| | - M Formica
- Dipartimento Di Scienze Chirurgiche E Diagnostiche Integrate, Università Degli Studi Di Genova - DISC, Viale Benedetto XV 6, 16132, Genova, GE, Italy
- Clinica Ortopedica, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genova, GE, Italy
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Zaidi R, Lewis TL, Ray R. The Role Of Minimally Invasive Osteotomies In Cavovarus Foot Reconstruction: Detailed Technique And Evidence For Procedures. Foot Ankle Clin 2023; 28:709-718. [PMID: 37863529 DOI: 10.1016/j.fcl.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
Percutaneous correction of cavus foot deformity can be achieved with satisfactory correction of foot anatomy and biomechanics. Surgical management of cavovarus foot reconstruction is an individualized combination of surgical procedures designed to correct deformity. Minimally invasive procedures using high-torque low-speed burr can facilitate large deformity correction without extensive soft tissue stripping. This article presents the operative technique for percutaneous cavus foot correction including a lateralizing calcaneal osteotomy and proximal first ray osteotomy. However, methodologically robust evidence to support this procedure is lacking at present, and further research, particularly, focusing on long-term clinical outcomes and follow-up is required.
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Affiliation(s)
- Razi Zaidi
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Thomas Lorchan Lewis
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Robbie Ray
- King's Foot and Ankle Unit, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK.
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Zhao JZ, Kaiser PB, DeGruccio C, Farina EM, Miller CP. Quality of MIS vs Open Joint Preparations of the Foot and Ankle. Foot Ankle Int 2022; 43:948-956. [PMID: 35382603 DOI: 10.1177/10711007221081865] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Minimally invasive surgery (MIS) is growing in the field of foot and ankle, and the MIS burr is an emerging tool. Although commonly used to perform osteotomies, the burr can also be used for arthrodesis joint preparation that traditionally would be performed through open incisions. To date, there is no study comparing the quality of joint preparation between using a fluoroscopy-guided MIS technique compared to traditional open techniques. The goal of this cadaveric study is to compare the percentage of joint surfaces prepared between MIS and open techniques for the most common joints that are fused in foot and ankle surgery. METHODS Open joint preparation was performed under direct visualization with open incisions. MIS joint preparation was performed percutaneously using fluoroscopic guidance alone, without arthroscopy. After joint preparation, cadaveric samples were disarticulated, and joint surfaces were analyzed for percentage of cartilaginous surface removed. The percentage of joint surface prepared was compared between the open and MIS techniques. RESULTS Ten cadaveric samples were used for the MIS technique and 5 samples for the open technique. Percentage of joint surface prepared was similar for all joint surfaces. CONCLUSION The MIS technique in the hands of experienced surgeons was found to provide overall similar percentages of surface area prepared compared to traditional open techniques. CLINICAL RELEVANCE MIS joint preparation may be useful for specific patient populations. This study suggests that MIS joint preparation is a reasonable, and possibly advantageous, alternative to open preparation in arthrodesis surgery when performed by experienced MIS surgeons.
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Affiliation(s)
- John Z Zhao
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
| | - Philip B Kaiser
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Christina DeGruccio
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Evan M Farina
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
| | - Christopher P Miller
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Lee DJ, Choi JY, Kim HS, Suh JS. Minimally invasive correction for symptomatic, fixed curly toe deformity. Foot Ankle Surg 2021; 27:60-65. [PMID: 32173282 DOI: 10.1016/j.fas.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/16/2019] [Accepted: 02/06/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Curly toe deformity is a relatively common deformity that generally occurs at the 4th and 5th proximal and/or middle phalanges but rarely presents with symptoms. Although numerous open operative techniques have been introduced, there is no established treatment yet. We report the results of minimally invasive correction for symptomatic, fixed curly toe deformity. METHODS Between 2016 and 2018, 25 consecutive percutaneous dorsolateral closing wedge-shaped osteotomies with Shannon burrs at the proximal and/or middle phalanx were performed. We assessed the postoperative clinical and radiological changes at a mean of 22.51 months of follow-up. RESULTS The locations of osteotomy were at the middle phalanx in 10 cases, proximal phalanx in 13 cases, and both in one case. The mean amount of corrections of varus inclination and shortening were 16.54° and 2.24 mm, respectively. The Foot and Ankle Ability Measure Activities of Daily Living scores significantly improved from 59.09 preoperatively to 74.55 at the last follow-up. There was one case of pin site infection and one case of incision site numbness due to digital nerve injury. CONCLUSIONS Minimally invasive dorsolateral closing wedge-shape osteotomy is a simple, safe, and effective correction for symptomatic, fixed curly toe deformity.
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Affiliation(s)
- Dong Joo Lee
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Jun Young Choi
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Hyung Suh Kim
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Jin Soo Suh
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, South Korea.
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Biomechanical results of percutaneous calcaneal osteotomy using two different osteotomy designs. Foot Ankle Surg 2020; 26:551-555. [PMID: 31371267 DOI: 10.1016/j.fas.2019.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/01/2019] [Accepted: 07/09/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Percutaneous osteotomy of calcaneus has been proposed to reduce the complication rate and became more and more popular. The bone cut can be performed as a straight or chevron-like (V) osteotomy using a Shannon burr. Comparative studies of straight or V-osteotomy as like as one or two screws in percutaneous calcaneal osteotomies are missing in the literature. We hypothesize that the V-osteotomy will result in a higher stiffness in biomechanical testing as the straight osteotomy using single screw for fixation. METHODS The straight osteotomy (9 fresh-frozen specimens) and V-osteotomy (9 fresh-frozen specimens) was performed and the calcaneal tuberosity was moved 10mm medially and slightly rotated. One 6,5mm cancellous compression screw was used for osteosynthesis. Specimens were preconditioned with 100N over 100 cycles. The force was increased after every 100N by 100N from 200 to 500N. This was followed by cyclic loading with 600N for 500 cycles. RESULTS Despite the higher mean values of the group with V-osteotomy, no significant difference was registered between the two groups regarding the stiffness at all force levels. A higher failure rate was observed in the group with straight osteotomy. CONCLUSION The moderate correlation of bone density and stiffness in the V-group, and significantly lower failure rate with no secondary dislocation in fluoroscopy indicates the superiority of the V-osteotomy in the present study. Whether the demonstrated advantages can be reflected in clinical practice should be investigated in further studies. LEVEL OF CLINICAL EVIDENCE 5.
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Park JH, Park KR, Kim D, Kwon HW, Lee M, Choi YJ, Kim YB, Park S, Yang J, Cho J. The incision strategy for minimizing sural nerve injury in medial displacement calcaneal osteotomy: a cadaveric study. J Orthop Surg Res 2019; 14:356. [PMID: 31718699 PMCID: PMC6852710 DOI: 10.1186/s13018-019-1411-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/14/2019] [Indexed: 12/03/2022] Open
Abstract
Background The skin incision for medial displacement calcaneal osteotomy (MDCO) often damages the sural nerve. We aimed to identify the practical reference area in which the surgeon can incise the skin to minimize the injury of the sural nerve during MDCO. Methods The foot and ankles of 20 cadavers were dissected. The landmarks were the following four anatomical references: point A, the tip of the lateral malleolus; point B, the inferior margin of the calcaneus on the vertical line through point A; point C, the posteroinferior apex of the calcaneus; and point D, the lateral border of the Achilles tendon on the horizontal line through point A. The distances from the sural nerve to points A and B in the vertical direction (lines D1 and D2, respectively), to points A and C in the diagonal direction (lines D3 and D4, respectively), and to points A and D in the horizontal direction (lines D5 and D6, respectively) were measured. Results The median ratios of D1 to D1+D2, D3 to D3+D4, and D5 to D5+D6 were 0.34 (range 0.25 to 0.45), 0.23 (range 0.16 to 0.33), and 0.38 (range 0.26 to 0.50), respectively. Conclusions The distance ratios according to easily identifiable references would be a more practical incision strategy for surgeons to minimize sural nerve injury in both open and minimally invasive/percutaneous MDCO.
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Affiliation(s)
- Jeong-Hyun Park
- Department of Anatomy & Cell Biology, Graduate School of Medicine, Kangwon National University, Kangwon, Republic of Korea
| | - Kwang-Rak Park
- Department of Anatomy & Cell Biology, Graduate School of Medicine, Kangwon National University, Kangwon, Republic of Korea
| | - Digud Kim
- Department of Anatomy & Cell Biology, Graduate School of Medicine, Kangwon National University, Kangwon, Republic of Korea
| | - Hyung-Wook Kwon
- Department of Anatomy & Cell Biology, Graduate School of Medicine, Kangwon National University, Kangwon, Republic of Korea
| | - Mijeong Lee
- Department of Anatomy & Cell Biology, Graduate School of Medicine, Kangwon National University, Kangwon, Republic of Korea
| | - Yu-Jin Choi
- Department of Anatomy & Cell Biology, Graduate School of Medicine, Kangwon National University, Kangwon, Republic of Korea
| | - Yong-Been Kim
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 200-704, Republic of Korea
| | - Suyeon Park
- Department of biostatistics, College of Medicine, Soonchunhyang University Hospital, Seoul, Republic of Korea
| | - Jinseo Yang
- Department of Neurosurgery, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Republic of Korea
| | - Jaeho Cho
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, 77, Sakju-ro, Chuncheon-si, Gangwon-do, 200-704, Republic of Korea.
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Abstract
UNLABELLED Minimally invasive techniques are readily applicable to calcaneal osteotomies and have the potential to accomplish hindfoot correction equivalent to open procedures with less morbidity and pain. Use of a guidance jig makes the procedure more predictable. While most anatomic features of the procedure are the same as those with open techniques, special care must be taken to avoid neurovascular injury because there is no open exposure. Anatomic guidelines have been established for appropriately localizing the osteotomy. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Thomas I Sherman
- 1 Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Gregory P Guyton
- 1 Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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