SLR - May 2023 - Andrew Greenberg, DPM
Title: Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort studyReference: de Cesar Netto C, Ehret A, Walt J, Chinelati RMK, Dibbern K, de Carvalho KAM, Tazegul TE, Lalevee M, Mansur NSB. Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study. Arch Orthop Trauma Surg. 2022 Mar 21. doi: 10.1007/s00402-022-04399-0. Epub ahead of print. PMID: 35312845.
Level of Evidence: Level II: prospective-cohort study
Reviewed By: Andrew Greenberg, DPM
Residency Program: NYU Langone Brooklyn Hospital, Brooklyn, NY
Podiatric Relevance: Patients often present with a variety of symptoms and pathologies related to a hypermobile first ray, like medial eminence pain with hallux abducto-valgus (HAV) or medial-longitudinal arch (MLA) pain with forefoot supinatus and posterior tibial tendon dysfunction (PTTD). A surgeon may want to address the biomechanical deforming influences with the stability of a fused 1st TMTJ and plantarflexed first ray, which this paper provides evidence for combining the Lapidus and Cotton procedures, into one procedure they coined LapiCotton. The authors hypothesized that their LapiCotton procedure would yield low complication rates, high fusion rates, and significant MLA correction.
Methods: LapiCotton was evaluated using a prospective-cohort study (2020-2021) which included patients with progressive collapsing flatfoot deformity (PCFD), midfoot arthritis (MA), and HAV, but did not exclude patients undergoing concomitant procedures. The LapiCotton includes a proprietary external jig and a dorsal-opening plantarflexory wedge allograft soaked in Iliac crest bone-marrow aspirate. Fusion rates and Meary’s angles were examined with pre-to-post-op weight-bearing CT (WBCT), and fusion defined >50% bony bridging between allograft wedge and bone. Complications were split into minor and major complications. Minor complications were defined as superficial dehiscence, superficial infection, and neuropraxia. Major complications were defined as deep dehiscence, deep infection warranting IV antibiotics or surgery, and need for re-operation.
Results: The study of 22 feet (77.3% female) with 50% PCFD, 27% MA, and 23% HAV, had a 91% fusion rate (≤ 3 m.o.), 9% minor and 4.5% major complication rates, and a statistically significant 9.4o average improvement of Meary’s angle. The median allograft was 8 mm, and fused with 73% crossing screws, 23% plate/screw fixations, 4% intramedullary nail. On average the patients were mostly female (73%), older (52.6 y.o.), and overweight (32.9 BMI).
Conclusions: The authors concluded that their LapiCotton surgery is a viable procedure to address a number of foot pathologies due to their high fusion rate, low complication rate, and a significant improvement of Meary’s angle. As the authors acknowledge, this is a preliminary study with limitations; namely, small sample size, no control group, short follow-up, concomitant procedures, and no patient-reported outcome measures (PROMs). However, future publications may support utilizing the LapiCotton, which may best surgically address a hypermobile first ray with hallux-abducto valgus and forefoot supinatus.