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Cychosz CC, Mizher R, Digiovanni GM, Jones AC, Conti MS, Ellis SJ. Correlation of Clinical Outcomes and Relative Position of the First Metatarsal After the Modified Lapidus Procedure. Foot Ankle Int 2024; 45:979-987. [PMID: 38872316 DOI: 10.1177/10711007241255378] [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: 06/15/2024]
Abstract
BACKGROUND Hallux valgus is a complex 3-dimensional deformity, and the modified Lapidus is a commonly used procedure to correct moderate to severe cases. Shortening and elevation of the first ray can occur with this procedure, which may result in increased pressure on the lesser metatarsal heads. However, there is currently no consensus regarding an accepted length and elevation of the first ray following the modified Lapidus. Therefore, the purpose of this study is to evaluate the impact of the position of the first ray on patient-reported outcome measures. METHODS This retrospective study identified 68 patients (72 feet) who underwent the modified Lapidus bunionectomy over a 4-year period at a single institution with a median follow-up of 24 months (range, 11-35.6 months). Patients were included if they were over 18 years of age, had pre- and postoperative weightbearing computed tomography (WBCT) scans, and preoperative and minimum 1-year postoperative Patient-Reported Outcome Measurement Information System (PROMIS) scores. PROMIS scores from 6 domains including physical function, pain interference, pain intensity, global physical health, global mental health, and depression were evaluated and compared pre- and postoperatively. Radiographic parameters were measured and compared before and after surgery. Paired t tests were used to evaluate the significance of pre- to postoperative changes. Differences between cohorts were compared using Mann-Whitney U test for continuous variables or Fisher exact test for categorical variables. Correlation between radiographic measurements and patient-reported outcomes were assessed using the Spearman rank rho estimate and visualized with scatterplots with a linear regression. RESULTS PROMIS physical function, pain interference, pain intensity, and global physical health improved significantly following the modified Lapidus (all P < .001); however, scores did not show any significant correlation with shortening of the first ray up to a maximum shortening of 4.8 mm. The length of the first metatarsal relative to the second decreased by an average of 2.7 mm following the procedure when measured on WBCT (P < .001), and 2.6 mm when measured on plain radiographs (P < .001). No significant elevation of the first ray was observed postoperatively. CONCLUSION This study revealed that the Lapidus bunionectomy resulted in significantly improved pain and physical function at short-term follow-up. The amount of first ray shortening and elevation that occurred in this cohort did not adversely affect patient-reported outcomes.
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Affiliation(s)
- Chris C Cychosz
- Slocum Center for Orthopedics and Sports Medicine, Foot and Ankle, Eugene, OR, USA
| | - Rami Mizher
- Hospital for Special Surgery, New York, NY, USA
| | | | | | - Matthew S Conti
- Hospital for Special Surgery, Foot & Ankle, New York, NY, USA
| | - Scott J Ellis
- Hospital for Special Surgery, Foot & Ankle, New York, NY, USA
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2
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Limaye N, Kotwal T, Alkhalfan Y, Lewis TL, Abbasian A. First tarsometatarsal arthrodesis for severe hallux valgus using the tension band principle - Technical tip and case series. Foot (Edinb) 2024; 58:102069. [PMID: 38325170 DOI: 10.1016/j.foot.2024.102069] [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: 05/25/2023] [Revised: 11/05/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Hallux valgus (HV) is a common foot pathology. Severe HV in the presence of Tarsometatarsal joint (TMTJ) instability is often managed with arthrodesis of the 1st TMTJ. There are concerns regarding non-union and malunion (particularly the early loss of inter-metatarsal angle correction before complete arthrodesis). We report our medium-term results of a small series of patients that underwent an evolved surgical technique utilising orthogonal staples and a transverse suture button fixation to address biomechanical concerns with traditional Lapidus arthrodesis. METHODS A retrospective study of a consecutive series of patients who underwent this surgical technique between February 2017 and May 2022. Clinical outcomes were validated through Patient-reported outcomes measures (PROMS); EuroQol-5 Dimension (EQ-5D) and Manchester-Oxford Foot Questionnaires (MOXFQ). Radiographic parameters (hallux valgus (HVA), intermetatarsal (IMA), distal metatarsal articular angle (DMAA)) were assessed. Union of the arthrodesis and complications were recorded. RESULTS During the study period, 9 feet underwent the procedure. Radiographic data was available for all nine and PROMS data for seven (77.8%). Significant improvement occurred in all radiographic deformity parameters at mean 6-month follow-up. Mean ± standard deviation correction calculated preoperatively as HVA 40.2°, IMA 19.3° and DMAA 15.8°, corrected to HVA 15.4°, IMA 5.8° and DMAA 5.9° postoperatively. (HVA; P < 0.001, IMA; P < 0.001, DMAA; P < 0.001) Clinical PROMs at mean follow-up of 2 years were MOXFQ 34.4 ± 25.2, EQ-5D-5 L 0.819 ± 0.150 and VAS pain 13.6 ± 13.6. There were no cases of non-union, Tibialis anterior tendon irritation or hallux varus. Complications included first MTPJ stiffness in one case and CRPS and dorsiflexion malunion of the first ray in another patient. CONCLUSION This preliminary study of the procedure used in this series confirm this is a safe surgical technique to address severe HV with a low rate of non-union and significant radiographic improvements. A larger patient dataset is needed to evaluate this procedure robustly.
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Affiliation(s)
- Neil Limaye
- Guy's and St Thomas Hospitals NHS Foundation Trust, London, UK
| | - Tejas Kotwal
- Guy's and St Thomas Hospitals NHS Foundation Trust, London, UK
| | | | - Thomas L Lewis
- Guy's and St Thomas Hospitals NHS Foundation Trust, London, UK
| | - Ali Abbasian
- Guy's and St Thomas Hospitals NHS Foundation Trust, Kings College University of London, London, UK.
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3
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Wu DY, Lam EKF. Radiological Analysis of the Syndesmosis Concept in Metatarsus Primus Varus and Hallux Valgus Deformities Recurrence Prevention. J Foot Ankle Surg 2024; 63:262-266. [PMID: 38056554 DOI: 10.1053/j.jfas.2023.11.014] [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: 07/12/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
Hallux valgus (HV) is a common deformity of the foot. Its postoperative recurrence is not uncommon and is closely related to the recurrence of its underlying metatarsus primus varus (MPV) deformity. The syndesmosis procedure uses 1 to 2 intermetatarsal cerclage sutures to realign the first metatarsal and then induces a biological bonding between the 2 metatarsals to prevent the MPV deformity from recurring. This radiological study aimed to assess its effectiveness in long-term MPV and HV deformities recurrence prevention. Ninety-two feet of 51 consecutive patients had syndesmosis procedures that were prospectively followed up for more than 1 y and up to 14 y, averaging 100.5 (SD 45.2) months. Patients underwent X-ray examinations regularly at fixed intervals of their feet. We used Hardy's methods in measuring the intermetatarsal angle (IMA), hallux valgus angle (HVA), and medial sesamoid position from standing foot X-rays. More than 450 relevant X-ray and photo images were submitted as Supplementary Material for online viewing and reference. There was a significant final correction of IMA from 14.30° (SD 2.70) to 6.70° (SD 1.75) (p < .0001). There was no significant increase in IMA after the sixth postoperative month to their final follow-up endpoints, regardless of their lengths. There was a significant final correction of HVA from 31.95° (SD 7.45) to 19.1° (SD 7.45) (p < .0001). This study reconfirmed past findings that the MPV deformity could be corrected without osteotomies. Creating a syndesmosis-like intermetatarsal bonding was effective for long-term MPV recurrence prevention. Three feet had postoperative stress fracture of the second metatarsal. However, the HV deformity correction was less satisfactory, and the reasons were explained.
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Affiliation(s)
| | - Eddy Kwok Fai Lam
- Department of Statistics & Actuarial Science, University of Hong Kong, Hong Kong, China
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4
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Nishikawa DRC, Duarte FA, Saito GH, da Silva DA, Mann TS, de Miranda BR, Mendes AAM, Prado MP. Is there a tolerance for extension of the first metatarsal after the Lapidus procedure? A clinical, functional, and hindfoot radiographic analysis. INTERNATIONAL ORTHOPAEDICS 2024; 48:103-109. [PMID: 37582981 DOI: 10.1007/s00264-023-05932-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/05/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Based on the tripod concept of load distribution, our study aimed to evaluate whether a slight extension of first metatarsal (M1) that may occur after the Lapidus procedure (LP) could alter the radiographic measurements of the hindfoot and influence clinical and functional outcomes. METHODS Twenty-five patients (27 feet) were reviewed. Hindfoot radiographic analysis was based on seven measurements. Clinical and functional outcomes were evaluated with self-reported questionnaires. Transfer metatarsalgia was also assessed. Correlation analysis was performed according to variations of the studied variables. RESULTS The average extension of the M1 was 4.26 degrees (p < 0.001). None of the hindfoot radiographic measurements changed significantly (p = 0.13, p = 0.50, p = 0.19, p = 0.70, p = 0.11, p = 0.36, p = 0.83). Patients improved on most questionnaires (p < 0.001). None presented transfer metatarsalgia. No correlation between M1 extension and clinical and functional outcomes was found. CONCLUSION Possibly there is a tolerance of M1 extension in which it does not alter the radiographic measurements of the hindfoot, overload the lesser metatarsals, or compromise clinical and functional outcomes.
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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Department of Orthopaedics, Hospital Do Servidor Público Municipal de São Paulo, 60, Castro Alves Street, Aclimação, São Paulo, SP, CEP: 01532-000, Brazil.
- Department of Orthopaedic Surgery, Clínica de Ortopedia E Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, São Paulo, SP, CEP: 05078-000, Brazil.
- Department of Orthopaedic Surgery, Hospital Alemão Oswaldo Cruz, 94, São Joaquim Street, Liberdade, São Paulo, SP, CEP: 01508-000, Brazil.
| | - Fernando Aires Duarte
- Department of Orthopaedic Surgery, Clínica de Ortopedia E Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, São Paulo, SP, CEP: 05078-000, Brazil
| | - Guilherme Honda Saito
- Department of Orthopaedic Surgery, Hospital Sírio-Libanês, 91, Dona Adma Jafet Street, Bela Vista, São Paulo, SP, CEP: 01308-050, Brazil
| | - Daniel Araújo da Silva
- Department of Orthopaedic Surgery, Hospital Alemão Oswaldo Cruz, 94, São Joaquim Street, Liberdade, São Paulo, SP, CEP: 01508-000, Brazil
| | - Tânia Szejnfeld Mann
- Department of Orthopaedic Surgery, Hospital Alemão Oswaldo Cruz, 94, São Joaquim Street, Liberdade, São Paulo, SP, CEP: 01508-000, Brazil
| | - Bruno Rodrigues de Miranda
- Department of Orthopaedics, Hospital Do Servidor Público Municipal de São Paulo, 60, Castro Alves Street, Aclimação, São Paulo, SP, CEP: 01532-000, Brazil
| | - Alberto Abussamra Moreira Mendes
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
| | - Marcelo Pires Prado
- Department of Orthopaedic Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, São Paulo, SP, CEP: 05652-900, Brazil
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Klavas DM, Rosemberg DL, Bordignon G, Lin J, Lee S, Bohl DD. Radiographic Forefoot Width Following Minimally Invasive Chevron Akin Bunionectomy. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114221148191. [PMID: 36755967 PMCID: PMC9900161 DOI: 10.1177/24730114221148191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Hallux valgus (HV) is a common cause of pain and deformity of the forefoot. Minimally invasive chevron Akin (MICA) bunionectomy is a method for HV correction associated with less pain and swelling, with early return to weightbearing in a regular shoe. The purpose of this study was to determine how the MICA procedure affects forefoot width. Methods Twenty-eight patients (26 female, 2 male; 9 left, 19 right) at a single institution who underwent primary MICA for HV correction by 3 treating surgeons were retrospectively reviewed. Pre- and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), bony forefoot width, and soft tissue forefoot width were measured by 2 independent observers. Radiographic measurements were calibrated using fifth metatarsal length. Wilcoxon signed rank test compared changes in HVA, IMA, DMAA, and forefoot widths. Pearson correlation coefficient evaluated association between HVA, IMA, DMAA, and changes in forefoot width. Results At mean follow-up of 5.4 (range 3-13.7) months, bony forefoot width decreased significantly by 3.7 mm (4%, P < .001) and soft tissue forefoot width decreased by 2.5 mm (2%, P < .01). Decrease in HVA was moderately correlated with change in bony forefoot width (r = .38, P < .05) and change in soft tissue forefoot width (r = .45, P < .05). Decrease in IMA was moderately correlated with change in bony forefoot width (r = .45, P < .05) and change in soft tissue forefoot width (r = .44, P < .05). Conclusion The MICA procedure resulted in modest, yet significant, decrease in both bony and soft tissue forefoot width. Decrease in HVA and IMA demonstrated moderate correlation with changes in forefoot width. Patients can be counseled on these changes leading up to, and after, MICA bunionectomy surgery. Level of Evidence Level III, retrospective comparative series.
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Affiliation(s)
- Derek M. Klavas
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, IL, USA,Derek M. Klavas, MD, Department of
Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St,
Chicago, IL 60612, USA.
| | - Dov L. Rosemberg
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, IL, USA,International Research Fellow of
Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, RJ, Brazil,International Scholar at the Midwest
Orthopedics at Rush (MOR), Chicago, IL, USA,RUSH-IBTS International Fellowship
Program, Chicago, IL, USA,Lab. Prof. Manlio Mario Marco Napoli,
Departamento de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de
Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Glaucia Bordignon
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, IL, USA,International Research Fellow of
Instituto Brasil de Tecnologias da Saúde (IBTS), Rio de Janeiro, RJ, Brazil,International Scholar at the Midwest
Orthopedics at Rush (MOR), Chicago, IL, USA,RUSH-IBTS International Fellowship
Program, Chicago, IL, USA,Hospital Municipal Universitário de
Taubaté, Taubaté, SP, Brazil
| | - Johnny Lin
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, IL, USA
| | - Simon Lee
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, IL, USA
| | - Daniel D. Bohl
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, IL, USA
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6
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Heifner JJ, Materón SR, Zhang L, Giovanni TPS. Union Rates With the Use of Structural Allograft in Lapidus Arthrodesis: A Comparison Between Two Fixation Constructs. J Foot Ankle Surg 2022; 62:91-95. [PMID: 35752550 DOI: 10.1053/j.jfas.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 02/03/2023]
Abstract
Although structural allograft has been previously described as acceptable practice for reconstructive foot and ankle surgery, results for an allograft bone wedge in Lapidus arthrodesis are unknown. Additionally, there is no consensus on the superiority of a single fixation construct in Lapidus cases. Our objective was (1) to report union rates for Lapidus arthrodesis with and without the use of an allograft bone wedge and (2) to determine if fixation construct impacts rates of union when using structural allograft. A review was performed for Lapidus cases with fixation constructs of 2 crossed compression screws (CS) and a medial locking plate with single transarticular screw (MPS), both with and without use of an allograft bone wedge. Inclusion required a CT scan to evaluate bony union. There was no significant difference in union rates (p = .41) between the use (90%) and the nonuse (97%) of an allograft bone wedge. Union rates were significantly different (p = .04) when comparing CS fixation (85%) and MPS fixation (98%). The comparative results between the fixation constructs highlight the importance of compression across the arthrodesis site as part of a robust fixation construct. Our findings demonstrate that the use of an allograft bone wedge in Lapidus arthrodesis may mitigate complications due to metatarsal shortening while providing satisfactory rates of union.
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Affiliation(s)
- John J Heifner
- St George's University School of Medicine, Great River, NY.
| | | | - Linglin Zhang
- Kennesaw State University Analytics and Data Science Institute, Kennesaw, GA
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7
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Do DH, Sun JJ, Wukich DK. Modified Lapidus Procedure and Hallux Valgus: A Systematic Review and Update on Triplanar Correction. Orthop Clin North Am 2022; 53:499-508. [PMID: 36208892 DOI: 10.1016/j.ocl.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This review article examines contemporary methods and assesses radiographic outcomes and postoperative complications following the modified Lapidus procedure. A systematic review demonstrated significant improvements in intermetatarsal angle, hallux valgus angle, and tibial sesamoid position. We are updating a modified Lapidus technique for achieving triplanar correction of hallux valgus. Two cases of hallux valgus, one primary and one recurrent, are presented. As demonstrated in the systematic review, outcomes of Lapidus procedures create future opportunities. Surprisingly, only 78% of the studies assessed for this review reported on the hallux valgus angle and only 33% reported on tibial sesamoid position.
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Affiliation(s)
- Dang-Huy Do
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883, USA
| | - Joshua Jian Sun
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883, USA
| | - Dane K Wukich
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, TX 75390-8883, USA.
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8
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Nishikawa DRC, Duarte FA, Saito GH, de Cesar Netto C, Miranda BRD, Prado MP. Correlation of first metatarsal sagittal alignment with clinical and functional outcomes following the Lapidus procedure. Foot Ankle Surg 2022; 28:438-444. [PMID: 34474967 DOI: 10.1016/j.fas.2021.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/21/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the effect of the variation of the first metatarsal (M1) sagittal alignment after the Lapidus procedure (LP) on clinical and functional outcomes, and transfer metatarsalgia. METHODS Twenty-nine patients who underwent a LP, with a mean follow-up of 20 months, were reviewed. Radiographic, clinical and functional measurements were compared. Clinical and functional questionnaires applied were the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) scale, lower extremity functional scale (LEFS) and SF-12, which is divided in physical (PCS-12) and mental-health (MCS-12) scales. Radiographic analysis of M1 sagittal alignment was based on the first metatarsal declination angle (FMDA) and Meary Angle (MA). Intermetatarsal angle (IMA) and hallux valgus angle (HVA) were also measured. RESULTS FMDA, IMA and HVA showed significant variation, but MA did not. Clinical and functional improvements were observed, except in MCS-12. No patient developed transfer metatarsalgia. A direct correlation was found between Δ-FMDA with Δ-PCS-12 and Δ-LEFS, meaning that excessive M1 dorsiflexion as measured by FMDA led to a decrease in PCS-12 and LEFS. Patients with Δ-FMDA of up to 3.2° of dorsiflexion were those who had significant improvements. CONCLUSION Dorsiflexion of M1 can lead to decreased outcomes as measured by PCS-12 and LEFS. However, satisfactory outcomes can be obtained even with some dorsal deviation of the M1. LEVEL OF EVIDENCE IV, retrospective case series.
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Affiliation(s)
- Danilo Ryuko Cândido Nishikawa
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital Alemão Oswaldo Cruz, 94, São Joaquim Street, Liberdade, CEP: 01508-000, São Paulo, SP, Brazil; Department of Orthopaedics, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, CEP: 05078-000 São Paulo, SP, Brazil.
| | - Fernando Aires Duarte
- Department of Orthopaedics, Foot and Ankle Surgery, Clínica de Ortopedia e Traumatologia Ortocity, 526, Brigadeiro Gavião Peixoto Street, Lapa, CEP: 05078-000 São Paulo, SP, Brazil.
| | - Guilherme Honda Saito
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital Sírio-Libanês, 91, Dona Adma Jafet Street, Bela Vista, CEP 1308-050, São Paulo, SP, Brazil.
| | - Cesar de Cesar Netto
- Department of Orthopaedics, Foot and Ankle Surgery, University of Iowa, Iowa City, IA 52242, USA.
| | - Bruno Rodrigues de Miranda
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital do Servidor Público Municipal de São Paulo (HSPM), 60, Castro Alves Street, Aclimação, CEP: 01532-000 São Paulo, SP, Brazil.
| | - Marcelo Pires Prado
- Department of Orthopaedics, Foot and Ankle Surgery, Hospital Israelita Albert Einstein, 627, Albert Einstein Avenue, Jardim Leonor, CEP: 05652-900 São Paulo, SP, Brazil.
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de Cesar Netto C, Ehret A, Walt J, Chinelati RMK, Dibbern K, de Carvalho KAM, Tazegul TE, Lalevee M, Mansur NSB. Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study. Arch Orthop Trauma Surg 2022; 143:2283-2295. [PMID: 35312845 PMCID: PMC10110656 DOI: 10.1007/s00402-022-04399-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Instability/collapse of the medial column has been associated with many conditions, particularly progressive collapsing foot deformity (PCFD), hallux valgus (HV), and midfoot arthritis (MA). Restoration of first ray length and sagittal plane alignment to restore the foot tripod is essential when treating these deformities. This study aimed to assess early results, healing, and complication rate of a distraction dorsal opening plantarflexion wedge allograft first tarsometatarsal joint fusion (LapiCotton Procedure) in patients with collapse/instability of the medial column. METHODS In this prospective cohort study, we included PCFD, HV, and MA patients that underwent a LapiCotton procedure. Fusion site healing was defined by > 50% bone bridging in both interfaces between allograft wedge and host bone using weight-bearing computed tomography (WBCT) after 3 months. First ray collapse radiographic correction and minor and major complications (deep dehiscence, deep infection, and reoperation) were assessed. RESULTS A total of 22 patients (22 feet) were included (11 PCFD, 6 MA, and 5 of HV patients). Mean follow-up was 5.9 months (range 3-12) and median allograft size was 8 mm (range 5-19 mm). Bone healing was observed in 91% of cases. Two minor complications (9%, both superficial dehiscence) and one major complication (4.5%, deep infection) were observed. Statistically significant improvement of the sagittal plane talus-first metatarsal angle was observed, with mean improvement of 9.4° (95% CI 6.7-12.1°; p < 0.0001). CONCLUSION In this prospective cohort study of 22 patients treated with the LapiCotton procedure for medial longitudinal arch collapse/instability, we observed a low complication rate (9% minor, 4.5% major), high healing rate after 3 months (91%), one clinically stable radiographic non-union (4.5%) and one unstable non-union (4.5%) needing reoperation. Our results demonstrate promising initial results for LapiCotton technique in treating collapse of the medial longitudinal arch in patients with PCFD, MA and HV deformities. Long-term results are needed to confirm these promising results. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Cesar de Cesar Netto
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Amanda Ehret
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Jennifer Walt
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | | | - Kevin Dibbern
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Kepler Alencar Mendes de Carvalho
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Tutku Erim Tazegul
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Matthieu Lalevee
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA.,Department of Orthopedic Surgery, Rouen University Hospital, Rouen, France
| | - Nacime Salomão Barbachan Mansur
- Department of Orthopedics and Rehabilitation, Carver College of Medicine, University of Iowa (UIOWA), 200 Hawkins Drive, Iowa City, IA, 52242, USA.,Department of Orthopedics and Traumatology, Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
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10
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Wang CS, Chiang CC, Tzeng YH, Yang TC, Lin CC. Response to "Letter Regarding: First-Ray Radiographic Changes After Flexible Adult Acquired Flatfoot Deformity Correction". Foot Ankle Int 2022; 43:459-460. [PMID: 35139687 DOI: 10.1177/10711007221077050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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11
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Del Vecchio JJ, Ghioldi ME, Chemes LN, Dealbera ED, Brue J, Dalmau-Pastor M. Percutaneous, intra-articular, chevron osteotomy (PeICO) for the treatment of mild-to-moderate hallux valgus: a case series. INTERNATIONAL ORTHOPAEDICS 2021; 45:2251-2260. [PMID: 34347130 DOI: 10.1007/s00264-021-05111-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Treatment for hallux valgus (HV) remains challenging. Third-generation percutaneous procedures try to reproduce chevron-type osteotomies to replicate their benefits, such as intrinsic stability and reproducibility. We report the first results using a percutaneous, intra-articular, chevron osteotomy (PeICO) technique that mimics the classic intra-articular open chevron procedure, associated with a percutaneous adductor tendon release (PATR) for the treatment of mild-to-moderate HV. METHODS From May 2015 to October 2018, a total of consecutive 114 feet (74 patients) were included. Primary outcome measures included radiographic (hallux valgus and intermetatarsal angles) and clinical parameters such as visual analog scale (VAS), FAAM Activities of Daily Living (ADL), and FAAM Sport, AOFAS Score, and MOXFQ, preoperatively and at final follow-up (Minimum 18 months). A patient satisfaction survey was also performed. Pronation and length of the first metatarsal were also assessed. Secondary outcomes included fluoroscopic time, length of surgery, complications, recurrence, and re-operation rates. RESULTS At 24.09 months on average, the AOFAS score improved from 52.1 points preoperatively to 91.1 (p < 0.001) at the latest follow-up. VAS decreased from 6.3 to 1. Also, FAAM ALD, FAAM Sport, and MOXFQ showed statistically significant differences (p < 0.001) when comparing pre-operative and post-operative periods. Patients found the procedure to be excellent in 82% and very good in 13.5% of cases. Our global complication and re-operation rates were 5.26% and 3.5% (screw removal), respectively. CONCLUSION PeICO combined with PATR proved to be a safe, reliable, and effective technique for the correction of mild-to-moderate HV deformity.
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Affiliation(s)
- Jorge Javier Del Vecchio
- Head Foot and Ankle Section, Orthopaedics Department, Fundación Favaloro, Hospital Universitario, Solis 461, CP 1078, Ciudad Autónoma de Buenos Aires (CABA), Argentina. .,Department of Kinesiology and Physiatry, Universidad Favaloro, Av. Entre Ríos 495, CABA, CP 1079, Argentina. .,Minimally Invasive Foot and Ankle Society (MIFAS By Grecmip), 2 Rue Georges Negrevergne, 33700, Merignac, France.
| | | | - Lucas Nicolás Chemes
- Foot and Ankle Section, Fundación Favaloro, Hospital Universitario, Buenos Aires, Argentina
| | - Eric Daniel Dealbera
- Foot and Ankle Section, Fundación Favaloro, Hospital Universitario, Buenos Aires, Argentina
| | - Julieta Brue
- Foot and Ankle and Limb Salvage Surgery Fellowship, Fundación Favaloro, Hospital Universitario, Buenos Aires, Argentina
| | - Miki Dalmau-Pastor
- Minimally Invasive Foot and Ankle Society (MIFAS By Grecmip), 2 Rue Georges Negrevergne, 33700, Merignac, France.,Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Abstract
Rotation of the first metatarsal (M1) as a potential etiological factor of hallux valgus (HV) deformity was described relatively early in the description of HV pathoanatomy. However, because biplanar radiographs have been the standard method for imaging HV, clinicians primarily developed measurement methods and corrective operations confined to 2 dimensions, medial-lateral and inferior-superior. Recently, as our understanding of HV pathoanatomy has further developed, aided in part by advanced imaging technology, M1 rotation about its axis ("axial rotation") and its implications for HV deformity and treatment has reemerged. The goal of this review is to summarize M1 rotation in HV from a historical perspective, to present the current understanding of its potential role in the etiology/pathogenesis of HV, and to summarize relevant imaging and operative considerations with respect to M1 rotation.Level of Evidence: Level III, systematic review.
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Affiliation(s)
- Jesse Steadman
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Alexej Barg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.,Department of Orthopaedics, Trauma and Reconstructive Surgery, University of Hamburg, Hamburg, Germany
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