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Minimally invasive distal linear metatarsal osteotomy for correction of hallux valgus: a preliminary study of clinical outcome and analytical radiographic results via a mapping system.
Angthong C, Yoshimura I, Kanazawa K, Hagio T, Ida T, Naito M.
Arch Orthop Trauma Surg. 2012 Dec 8
To date, actual results of a minimally invasive distal linear metatarsal osteotomy (DLMO) via more explicit radiographic delineation are poorly understood and radiographic findings and clinical results have not been systematically correlated. Purposes of this study were (1) to evaluate the effectiveness of DLMO using a precise radiographic mapping system; and (2) to determine the relationship between radiographic outcomes and clinical results.
MATERIALS AND METHODS:
In 2008-2011, DLMO was performed in 30 patients (36 feet) who had reducible symptomatic hallux valgus. Clinical data were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographs were reviewed at preoperative and final follow-up for delineations of first ray construct, hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle, and other radiographic profiles. Correlation between postoperative AOFAS score and degree of malalignment was also analyzed.
A total of 36 feet had predominantly moderate hallux valgus (26 feet with HVA: 21-39°; 23 feet with IMA: 12-17°). Mean preoperative and postoperative AOFAS scores were 70.2 ± 11.3 and 95 ± 6.4, respectively (p < 0.001). Mapping system revealed improvements of first ray construct deformity (p < 0.05). Significant reductions in all angular measurements were observed at final follow-up period (p < 0.001) and correlated significantly with changes in AOFAS score (p < 0.001). Nine feet (25 %) were observed with recurrence of deformity which showed HVA >15°. Significant sesamoid lateralization was observed (p < 0.05). Twenty-four feet (66.7 %) showing overall sagittal malunions were found with significant plantar angulation (p = 0.026) and non-significant plantar displacement compared with preoperative reference (p = 0.43). These radiographic abnormalities were not related to clinical outcomes including postoperative AOFAS scores (p > 0.05).
DLMO is an acceptable procedure to correct reducible hallux valgus in most patients with moderate level of severity. Sagittal malunion, recurrence, and sesamoid lateralization are possibly radiographic abnormalities but are not associated with clinical impairments.
The potential advantages of minimal incision surgery for hallux valgus (HV) correction are the following: reduced surgical exposure, diminished soft-tissue stripping, and less blood supply impairment. These advantages imply fewer complications. We retrospectively reviewed patients who were consecutively treated with a modified minimally invasive osteotomy from January 2006 until December 2009 for HV deformity. We radiographically assessed the HV angle, 1-2 intermetatarsal (IM) angle, and tibial sesamoid position. Clinical outcomes were determined using the American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal (AOFAS HMI) Clinical Rating Scale. A paired Student’s t test was used to determine significance, with P < .01. There were 126 patients (146 feet) with an average age of 52.6 years and an average postoperative follow-up of 29.1 months. Preoperatively, the average HV angle was 32.3°, and postoperatively, it was 4.5° (P < .01). The preoperative average IM angle was 14.4°, whereas postoperatively, it was 4.8° (P < .01). The average tibial sesamoid position was 6.3 preoperatively and 2.5 postoperatively (P < .01). The average AOFAS HMI score was 54.6 preoperatively and 85.3 postoperatively (P < .01). There were 15 postoperative complications (10.3%) that included hallux varus, painful hardware, and delayed union. The results are comparable with those of traditional open techniques, with the additional advantages of a minimally invasive procedure.
Midterm Results and Complications After Minimally Invasive Distal Metatarsal Osteotomy for Treatment of Hallux Valgus.
Iannò B, Familiari F, De Gori M, Galasso O, Ranuccio F, Gasparini G. Foot Ankle Int. 2013 Mar 5.
Minimally invasive distal metatarsal osteotomy (MIDMO) is a common technique used to correct the hallux valgus deformity, but controversy remains regarding the expected outcomes of this surgery.
Seventy-two patients (85 feet) suffering from hallux valgus underwent MIDMO with a modified Bösch technique. Patients were prospectively evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, and the AOFAS recovery rate was calculated. Before surgery and at follow-up, the hallux valgus (HVA), intermetatarsal (IMA), and distal metatarsal articular (DMAA) angles were measured, and the severity of disease was categorized according to the preoperative HVA. The tibial sesamoid position and articular congruence were evaluated. Postoperative complications were noted.
After an average follow-up of 73.3 ± 38.1 months, the total AOFAS score improved from 47.6 ± 13.3 to 87.3 ± 11.5 (P < .001). The HVA decreased from 34.7 ± 8.2 to 14.8 ± 7.8 degrees, the IMA from 14.7 ± 4 to 6.6 ± 3.6 degrees, and the DMAA from 20.9 ± 9.8 to 9 ± 6.6 degrees (P < .001 for all). Postoperative improvement in AOFAS was inversely related to the preoperative severity of disease (P < .001, β = -.378). Sixteen (18.8%) deformity recurrences were noted, 9 of which were observed in patients with preoperative HVA more than 40 degrees. Worse preoperative congruence of the metatarsophalangeal joint and tibial sesamoid position correlated with a higher rate of recurrence of the disease after surgery (P = .001, β = -.353 and P < .001, β = .427, respectively).
Satisfactory clinical and radiological results can be expected after MIDMO, but caution should be exercised when using this technique because of the likelihood of possible complications (29.4% overall complication rate). Predictors of surgical outcomes can be used to select the best candidates for this surgery.