Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2023; 14(12): 843-852
Published online Dec 18, 2023. doi: 10.5312/wjo.v14.i12.843
Role of lateral soft tissues release in percutaneous hallux valgus correction: A medium term retrospective study
Fabio Zanchini, Ottorino Catani, Fabrizio Sergio, Alessia Boemio, Angelo Sieczak, Davide Piscopo, Salvatore Risitano, Gabriele Colò, Federico Fusini
Fabio Zanchini, Division of Orthopaedics and Traumatology, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Clinical Orthopeadics, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
Ottorino Catani, Department of Foot Surgery, Casa di cura Santa Maria, Santa Maria Capua Vetere 81055, Italy
Fabrizio Sergio, Department of Foot an Ankle Surgery, Casa di cura Santa Maria, Santa Maria Capua Vetere 81055, Italy
Alessia Boemio, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Clinical Orthopeadics, AOU Luigi Vanvitelli, Napoli 80138, Italy
Angelo Sieczak, Davide Piscopo, Clinical Orthopeadics, University of Campania Luigi Vanvitelli, Naples 80138, Italy
Salvatore Risitano, Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Città della Salute e della Scienza di Torino, Turin 10126, Italy
Gabriele Colò, Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Alessandria 15121, Italy
Federico Fusini, Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, Cuneo 12084, Italy
Author contributions: Zanchini F, Catani O, and Sergio F designed the research study and performed the research; Boemio A, Sieczak A, and Piscopo D analyzed the data and wrote the manuscript; Colò G and Fusini F share co-last authorship, and they revised the text of the manuscript; and all authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Comitato Etico dell’Istituto Clinica Ortopedica AOU Luigi Vanvitelli, Campania.
Informed consent statement: This is to certify that signature of a consent form for the study was waived by our Institutional Review Board for the current study because of its retrospective nature and part of our service evaluation assessment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at boemioale@gmail.com Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fabio Zanchini, MD, PhD, Professor, Division of Orthopaedics and Traumatology, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Clinical Orthopeadics, University of Campania “Luigi Vanvitelli”, Vico L. de Crecchio, Naples 80138, Italy. fabio.zanchini@unicampania.it
Received: August 10, 2023
Peer-review started: August 10, 2023
First decision: September 28, 2023
Revised: October 12, 2023
Accepted: November 17, 2023
Article in press: November 17, 2023
Published online: December 18, 2023
Processing time: 126 Days and 21.1 Hours
Abstract
BACKGROUND

In the field of minimally invasive surgery (MIS) for the treatment of hallux valgus (HV), different techniques have begun to emerge in the literature concerning the distal osteotomy of the first metatarsal bone, the synthesis or not of the metatarsal head, the possible association with lateral soft tissues release (LSTR) and osteotomy of the base of the first phalanx.

AIM

To evaluate the role of LSTR on percutaneous HV correction, evaluating functional and radiographical results.

METHODS

From January 2012 to May 2016 a total of 396 patients with mild to moderate symptomatic HV treated with the MIS technique were included in this retrospective study. The technique provides no internal fixation (WOS). Patients were divided into the LSTR group and no LSTR group (LSTR N). This surgical procedure (LSTR) was reserved for insufficient HV angle (HVA) correction during fluoroscopic control. Patients were evaluated at each follow-up by two other authors after appropriate training by senior authors (first practitioners). Clinical evaluation was performed before surgery, 6 mo after surgery, and 48 mo follow-up. American Orthopaedic Foot and Ankle Society (AOFAS) and visual analog scale (VAS) score was used to evaluate pain and function, and complications were recorded. In addition, the incidence of relapses and the degree of joint range of motion (ROM) with the association with the LSTR (capsule, adductor tendon, phalanx-sesamoid ligament, and the deep transverse metatarsal ligament) were evaluated. Radiological parameters included HVA and intermetatarsal angle (IMA). Patient satisfaction was assessed. Student t-test and Fisher exact test were used to assess statistical analysis.

RESULTS

From our study it is clear that no differences in term of HVA, VAS, IMA correction, rate of complications, and AOFAS score were found between groups, while a significant improvement of the same variables was found in each group between pre and postoperative values. A significant improvement in ROM at 6 mo (P = 0.018) and 48 mo (P = 0.02) of follow-up was found in LSTR N group. Complications were rare in both groups.

CONCLUSION

LSTR procedure on percutaneous HV correction seems to increase postoperative joint stiffness with a comparable incidence of relapse and a low incidence of complications.

Keywords: Hallux valgus; Percutaneous distal osteotomy; Lateral release; Minimally invasive surgery; Without ostheo-synthesis; Range of motion

Core Tip: Our study evaluated a court of 396 patients treated with percutaneous technique, pain particular attention to the influence of the lateral soft tissues release (LSTR) on postoperative joint range of motion (ROM) and hallux valgus recurrence. A significant difference in ROM was recorded in the group where the LSTR was carried out, while there was no superior incidence of relapse between groups. ROM was revealed better at follow-up in LSTR not performed group. We believe these data represent an essential element to understanding the etiopathogenesis of complications. This data also enhances the validity of minimally invasive surgery with no osteosynthesis technique.