title: Effect of Lateral Soft Tissue Release on Sesamoid Position in Hallux Valgus Surgery.
abstract: BACKGROUND
  The effect of lateral soft tissue release (LSTR) regarding the position of the sesamoid is not clear. The purpose of this study was to evaluate the effect of LSTR by comparing the radiologic and clinical outcomes of operative treatment for hallux valgus with or without LSTR.
  
  
  METHODS
  This study included a consecutive series of chevron osteotomy of 119 feet of 90 patients with symptomatic hallux valgus with incongruent first metatarsophalangeal (MTP) joints. Fifty-one feet underwent an operation with the LSTR procedure (LSTR group), and the remaining 68 feet underwent treatment without LSTR (control non-LSTR group). We evaluated the differences regarding the distance of the fibular sesamoid from the second metatarsal bone between these 2 groups to evaluate the effect of LSTR on sesamoid position. The tibial sesamoid position was also investigated to evaluate the degree of reduction of the metatarsal head to the sesamoids. The hallux valgus angle, intermetatarsal angle, and distal metatarsal articulation angle were analyzed as radiologic outcomes. Additionally, the preoperative and final follow-up American Orthopaedic Foot & Ankle Society hallux MTP-IP scores and complications were evaluated as clinical assessments. The mean follow-up period was 43.3 weeks (range = 12-144).
  
  
  RESULTS
  There were no significant differences in the amount and direction of movement of the fibular sesamoid between the LSTR group and non-LSTR group (1.9 mm and 1.6 mm, respectively) (P = .23). The direction was close to the second metatarsal bone in both groups. The complication rate in the LSTR group was 7.8% (n = 4) and 2.9% (n = 2) in the non-LSTR group (P = .40).
  
  
  CONCLUSIONS
  Although there were significantly improved clinical and radiologic outcomes after surgery, the LSTR procedure did not result in medial shift or reduction of the sesamoid position.
  
  
  METHODS
  Level III, retrospective case control study.
authors.affiliation: Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Kyungjei
authors.initials: K
authors.lastname: Woo
authors.affiliation: Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: In-Sang
authors.initials: IS
authors.lastname: Yu
authors.affiliation: Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jun-Ho
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea kissung@gmail.com.
authors.forename: Ki-Sun
authors.initials: KS
authors.lastname: Sung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006215:Hallux Valgus / Q000601:surgery*; D006801:Humans; D017746:Joint Capsule / Q000601:surgery; D008023:Ligaments, Articular / Q000601:surgery; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010027:Osteotomy / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D012716:Sesamoid Bones / Q000000981:diagnostic imaging*; D013710:Tendons / Q000601:surgery; D055815:Young Adult
keywords: hallux valgus; lateral soft tissue release; repositioning; sesamoid