The Correction Potential of the Lateral Release of the Hallux Valgus: A Comparative Anatomical Study of Minimally Invasive Versus Open Surgical Technique Using a Dorsal Approach

• Published in: Indian journal of orthopaedics 2022-05, Vol.56 (5), p.887-894
• Main Authors: Klos, Kajetan, Lenz, Mark, Hofmann, Gunther O., Schubert, Wiebke, Knobe, Matthias, Roth, Klaus Edgar, Simons, Paul, Aurich, Matthias
• Format: Article
• Language: English
• Subjects: Conservative Orthopedics; Medicine; Medicine & Public Health; Original; Original Article; Orthopedics; Surgical Orthopedics
• ISSN: 0019-5413; 1998-3727
• DOI: 10.1007/s43465-021-00575-3

Background Lateral release (LR) is an integral part of surgical correction of hallux valgus. A comparison was made between the open and minimally invasive LR techniques using a dorsal approach. The reliability and safety of the two methods were compared. Besides, the release of specific structures was investigated with special emphasis on ascertaining if the release was partial or a total one. Methods In this study on cadavers, LR was performed on nine pairs of foot and ankle specimens. The group assignments were randomized for each case. The operations were followed by anatomical preparation, data collection, photo documentation, and statistical analysis. Results A statistically significant advantage was observed with the open dorsal approach as there was a complete release of the adductor hallucis muscle from the lateral sesamoid and the lateral metatarsosesamoid ligament ( p  = 0.015 in each case). In terms of releasing the adductor hallucis muscle from the proximal phalanx, the lateral joint capsule, and the lateral collateral ligament, none of the investigated procedures showed better performance. However, open dorsal access tends to show a higher degree of release more frequently. Conclusions Splitting of the lateral joint capsule, including the lateral collateral ligament and lateral metatarsosesamoid ligament via the dorsal approach can be performed reliably and completely using the open surgical technique. The open dorsal technique shows better rates of detachment when the adductor hallucis muscle is released from the lateral sesamoid. Both techniques resulted in incomplete release of the adductor hallucis muscle from the proximal phalanx. Study Type Therapeutic—investigating the results of a treatment. Level of Evidence II (Prospective cohort study).