SLR - October 2023 - Uptegraph
Title: Comparison of modified U-shaped and inverted L-shaped medial capsulorrhaphy in hallux valgus surgery: a prospective, randomized controlled trial of 75 patientsReference: Wei X, Liu X, Zhang P, Liu S. Comparison of modified U-shaped and inverted L-shaped medial capsulorrhaphy in hallux valgus surgery: a prospective, randomized controlled trial of 75 patients. J Orthop Surg Res. 2023 Apr 24;18(1):313. doi: 10.1186/s13018-023-03799-1. PMID: 37095553; PMCID: PMC10123971.
Level of Evidence: II
Reviewed By: Gabrielle Uptegraph, DPM
Residency Program: Inova Fairfax Medical Campus, Fairfax, VA
Podiatric Relevance: Medial capsulorrhaphy is a powerful soft tissue procedure that can be used to reinforce HAV correction after bony osteotomy. The distal soft tissue structures will assist in restoration of the physiological balance at the first metatarsal head. Many studies emphasize the release of the lateral soft tissue but there are few studies that focus on the effect of specific medial soft tissue repair and surgical outcomes with regards to hallux valgus surgery.
Methods: 78 patients separated into 2 groups according to medial capsule closing techniques: a modified U-shaped capsulorrhaphy and an L-shaped. Post-op evaluation after at least 1 year included WB radiographs, ROM at the 1st MTPJ, and AOFAS scores. Mann-Whitney U-test was used to compare.
Results: Hallux valgus angle (HVA) and intermetatarsal angle (IMA) and AOFAS score improved from 29.5 to 7/1, 13.4 to 7.1, and 53.4 to 85.5 respectively in group U. HVA, IMA, and AOFAS in group L improved from 31.2 to 9.6, 13.5 to 7.8, and from 52.3 to 86.6, respectively. Mean ROM in group U at 1-year post-op was 53.5 degrees from 66.3 degrees pre-operatively, and 47.5 degrees post-op from 63.3 degrees pre-operatively in Group L.
Conclusions: In this study, both groups returned to normal angles postoperatively. However, at 1 year the HVA was better maintained in the group that received the U-shaped capsulorrhaphy. It was noted that recurrence was seen in 4 patients that had a L-shaped capsulorrhaphy compared to 1 recurrence in the U-group. In addition, the ROM at the 1st MTP joint was preserved to a greater degree in the modified U-shaped group. This suggests that medial soft tissue repair should be considered more carefully when aiming to limit recurrence and maintain correction.