Metatarsal Approximation as a Viable Alternative to Chevron Osteotomy for Hallux Abducto Valgus (HAV) Correction

Yechiel Gellman Nissim Khaimov Jorge Fishleder Amir Haze Efraim Leibner Ofer Elishuv Eli London
Department of Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel

Background: Many procedures have been described for correction HAV deformity. Pathogenesis is believed to be the hypermobility of the first ray. We hypothesized that a loose lateral ligament in combination with metatarsal 1-2 approximation might suffice to withhold a HAV correction and limit the hypermobility of the ray. This was achieving using a simple absorbable suture.
Patients and Methods: A retrospective cohort study was conducted. Two groups were identified: the chevron osteotomy and the MT1-2 approximation (MT12ap) group which underwent lateral loosening, release of the abductor halluces lungus (virtually a Mcbride procedure) and additionally approximating the first metatarsals by means of an absorbable Vicril suture. Radiographic measurements, including HVA, IMA, DMMA, HVI and sesmoid subluxation were noted prior to operation, immediately post-op and on final follow-up. Complications were noted on follow up.

Results: Thirty-nine patients were included. Twenty-one patients in the chevron group and nineteen in MT1ap group without a distal chevron osteotomy. The demographics in both groups were similar. Radiographic measures prior to operation were also similar (cohort average of HVA, IMA, DMAA, HVI and sesmoid subluxation were 30.6±7.6, 12.7±3.7, 25.1±9.2, 10.6±5.2 and 4.7±1.3, respectively).

Immediate post-operative measurement showed a higher HVA in the MT12ap group (18.5±9.7 vs. 12.2±6.7, P<0.05) while other measurements did not differ significantly. On final follow-up (average 5.9 months), there was no significant differences between the two groups. Seven complications were noted with a similar amount of complications in both groups (one local ischemia, two scar complication, one loss of sensation and three revisions).

Conclusions: Shortening the lateral ligaments of the MTPJ1 in combination with metatarsal 1-2 approximation using a simple suture had shown similar radiographic results in the follow-up for HAV repair. This method, which is considerably less-costly, faster and probably less-painful, than other methods involving osteotomy can be a viable option. Nonetheless, one should consider the complication rate in such a procedure. Further research is needed to address these issues and a long term follow-up is required.