title: Functional and radiographic outcomes of hallux valgus correction by mini-invasive surgery with Reverdin-Isham and Akin percutaneous osteotomies: a longitudinal prospective study with a 48-month follow-up.
abstract: BACKGROUND
  Minimally invasive surgery (MIS) represents one of the most innovative surgical treatments of hallux valgus (HV). However, long-term outcomes still remain a matter of discussion within the orthopaedic community. The purpose of this longitudinal prospective study was to evaluate radiographic and functional outcomes in patients with mild-to-severe HV who underwent Reverdin-Isham and Akin percutaneous osteotomy, following exostosectomy and lateral release.
  
  
  METHODS
  Eighty patients with mild-to-severe symptomatic HV were treated by MIS. Clinical evaluation was assessed preoperatively, as well as at 3 and 12 months after surgery and at final follow-up of 48 months, using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux grading system. Patient satisfaction and complications were recorded. Computer-assisted measurement of antero-posterior radiographs was taken preoperatively, as well as at 3 and 12 months after surgery and at 48-month follow-up, analysing the intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA) and the tibial sesamoid position. Also, the bridging bone/callus formation was evaluated at the different radiographic follow-ups, while the articular surface congruency and the metatarsal index were calculated only preoperatively and at the last follow-up. Patient satisfaction was assessed using the visual analogue score (VAS). Statistical analysis was carried out using the paired t test. Statistical significance was set at p < 0.05.
  
  
  RESULTS
  The mean AOFAS score was 87.15 points at the final follow-up of 48 months, and the VAS score was 8.35/10. The post-operative radiographic assessments showed a statistically significant improvement compared with preoperative values. The mean corrections of each angular value at the last follow-up were as follows: IMA 3.90°, HVA 12.50°, DMAA 4.72° and a tibial sesamoid position of 1.10. The articular surface was congruent in 77 (96.25%) cases and incongruent only in 3 (3.75%). The complete healing of the osteotomies was achieved in all series at 3-month follow-up. However, the results obtained in the correction of the severe HV deformities were less encouraging.
  
  
  CONCLUSIONS
  Minimally invasive surgery with Reverdin-Isham and Akin percutaneous osteotomy, in combination with previous exostosectomy and subsequent lateral soft-tissue release, is a safe, effective and reliable procedure for correction of mild-to-moderate HV. However, it requires a long learning curve because of the inherent difficulty of the mixed different surgical procedures.
  
  
  BACKGROUND
  ClinicalTrials.gov PRS Protocol Registration and Results System: NCT02886221.
authors.affiliation: Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy. carlo.biz@unipd.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Biz
authors.affiliation: Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Fosser
authors.affiliation: Human Anatomy and Embryology Unit, Experimental Pathology and Therapeutics Department, University of Barcelona, Barcelona, Spain.|Health Sciences Faculty of Manresa, University of Vic-Central University of Catalunya, Barcelona, Spain.
authors.forename: Miki
authors.initials: M
authors.lastname: Dalmau-Pastor
authors.affiliation: Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Corradin
authors.affiliation: Orthopaedic and Trauma Unit, Padua Hospital, via Giustiniani 2, Padova, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Rodà
authors.affiliation: Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Aldegheri
authors.affiliation: Orthopaedic Clinic, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, via Giustiniani 2, 35128, Padova, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ruggieri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006215:Hallux Valgus / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000639:trends; D010027:Osteotomy / Q000379:methods; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D011859:Radiography / Q000379:methods / Q000639:trends; D020127:Recovery of Function / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Akin osteotomy; First ray; Forefoot; Hallux valgus; Minimally invasive surgery; Percutaneous distal osteotomy; Reverdin-Isham osteotomy