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  • Title: A prospective study to compare the operative outcomes of minimally invasive proximal and distal chevron metatarsal osteotomy for moderate-to-severe hallux valgus deformity.
    Author: Choi JY, Kim BH, Suh JS.
    Journal: Int Orthop; 2021 Nov; 45(11):2933-2943. PubMed ID: 34272980.
    Abstract:
    PURPOSE: The effectiveness of minimally invasive surgery (MIS)-distal chevron metatarsal osteotomy (DCMO) for the correction of moderate-to-severe hallux valgus deformity is unclear. This study aimed to compare the radiographic and clinical outcomes of our novel MIS-proximal chevron metatarsal osteotomy (PCMO) with those of MIS-DCMO performed during the same timeframe. METHODS: We prospectively compared the outcomes of patients who underwent MIS-PCMO (n = 20 patients; 22 cases) with those of patients who underwent MIS-DCMO (n = 23 patients; 26 cases) for moderate-to-severe hallux valgus deformity (hallux valgus angle [HVA] ≥ 30° and first-to-second intermetatarsal angle [IMA] ≥ 13°) between June 2017 and January 2019. The minimum follow-up duration for study inclusion was two years. The HVA, IMA, distal metatarsal articular angle (DMAA), relative length of the second metatarsal, medial sesamoid position, and Meary's angle to evaluate the degree of deformity correction and its maintenance were measured pre-operatively and at the final follow-up. RESULTS: Compared with MIS-DCMO, MIS-PCMO resulted in significantly greater correction of the HVA (P < 0.001) and IMA (P = 0.01), along with Meary's angle improvement (P < 0.001); however, the DMAA worsened (P = 0 .01). Furthermore, a significantly greater change was found in the relative second metatarsal length in the MIS-DCMO group (P = 0.01). No significant between-group differences were noted in the correction of the medial sesamoid position (P = 0.445). CONCLUSION: Compared with MIS-DCMO, MIS-PCMO can be a better option for correcting moderate-to-severe hallux valgus deformities. However, this technique should be applied carefully when the pre-operative DMAA is already large because the DMAA can become worse post-operatively.
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