SLR - October 2023 - Siegel
Title: Third-Generation Minimally Invasive Chevron Akin Osteotomy for Hallux Valgus: Three-Year OutcomesReference: Yousaf A, Saleem J, Al-Hilfi L, Kunasingam K. Third-Generation Minimally Invasive Chevron Akin Osteotomy for Hallux Valgus: Three-Year Outcomes. Indian J Orthop. 2023 Jun 5;57(7):1-7. doi: 10.1007/s43465-023-00917-3. Epub ahead of print. PMID: 37362227; PMCID: PMC10240454.
Level of Evidence: Level 4 case series
Reviewed By: David Siegel, DPM
Residency Program: Inova Fairfax Medical Campus, Fairfax, VA
Podiatric Relevance: Percutaneous surgery has evolved rapidly in the last decade due to less collateral tissue damage resulting in measurable decreases in morbidity. Minimizing incisions or incision size decreases the risk for wound complications and allows for a more rapid functional recovery with less post operative pain. Numerous minimally invasive techniques to correct hallux valgus have been described, one being minimally invasive chevron akin (MICA) which has shown excellent short-term results. One concern about MICA, or minimally invasive hallux valgus surgery in general is that there is a lack of long term follow up data. This study provides three-year outcomes for this specific procedure.
Methods: 33 patients who underwent third-generation MICA surgery were reviewed in terms of AOFAS and MOXFQ scores, Coughlin scale, radiographic outcomes, and complications.
Results: At an average of 36 months, mean AOFAS and MOXFQ scores improved from 48.2 to 95.6 and 57.6 to 6.7 respectively. 81.8% of patients rated their outcome as ‘Excellent’ and 18.2% as ‘Good’ using the Coughlin scale. At 36 months, HVA and mean IMA decreased from 34.6 degrees to 16.0 degrees and from 13.1 to 6.1, respectively
Conclusions: This case series shows that third-generation MICA provides good clinical outcomes at 3-year follow up in terms of AOFAS and MOXFQ scores with a majority of patients reporting excellent outcomes. Patients also maintained adequate IMA reduction at 3-year follow up. The authors reported that there was no statistically significant difference between 12 month and 36 month hallux valgus angle but average hallux valgus angle at final follow up was 16 degrees, which by the standard of many articles would meet the definition for recurrence. These patients should be followed for additional years to determine if these deformities begin to recur.