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The Correction Potential of the Lateral Release of the Hallux Valgus: A Comparative Anatomical Study of Minimally Invasive Versus Open Surgical Technique Using a Dorsal Approach

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Abstract

Background

Lateral release (LR) is an integral part of surgical correction of hallux valgus. A comparison was made between the open and minimally invasive LR techniques using a dorsal approach. The reliability and safety of the two methods were compared. Besides, the release of specific structures was investigated with special emphasis on ascertaining if the release was partial or a total one.

Methods

In this study on cadavers, LR was performed on nine pairs of foot and ankle specimens. The group assignments were randomized for each case. The operations were followed by anatomical preparation, data collection, photo documentation, and statistical analysis.

Results

A statistically significant advantage was observed with the open dorsal approach as there was a complete release of the adductor hallucis muscle from the lateral sesamoid and the lateral metatarsosesamoid ligament (p = 0.015 in each case). In terms of releasing the adductor hallucis muscle from the proximal phalanx, the lateral joint capsule, and the lateral collateral ligament, none of the investigated procedures showed better performance. However, open dorsal access tends to show a higher degree of release more frequently.

Conclusions

Splitting of the lateral joint capsule, including the lateral collateral ligament and lateral metatarsosesamoid ligament via the dorsal approach can be performed reliably and completely using the open surgical technique. The open dorsal technique shows better rates of detachment when the adductor hallucis muscle is released from the lateral sesamoid. Both techniques resulted in incomplete release of the adductor hallucis muscle from the proximal phalanx.

Study Type

Therapeutic—investigating the results of a treatment.

Level of Evidence

II (Prospective cohort study).

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Data Availability

Any underlying research materials related to this paper can be accessed on request by the corresponding author.

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Acknowledgements

The authors like to thank the human donors for the consent to use their tissue for scientific studies. We also thank Dr. Fröber and the team of the Institute of Anatomy of the University of Jena for the access to the human tissue and their support of this study. In addition, we would like to thank Editage (www.editage.com) for English language editing. The first author (K.K.) and the second author (M.L.) contributed equally to this manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

  1. Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany

    Kajetan Klos, Mark Lenz & Gunther O. Hofmann

  2. Gelenkzentrum Rhein-Main, Fuß- Und Sprunggelenkschirurgie, Frankfurter Straße 94, 65239, Hochheim, Germany

    Kajetan Klos, Klaus Edgar Roth & Paul Simons

  3. Department of Trauma- and Reconstructive Surgery, Berufsgenossenschaftliche Kliniken Bergmannstrost, Merseburger Str. 165, 06112, Halle (Saale), Germany

    Gunther O. Hofmann & Matthias Aurich

  4. Department of Anesthesiology and Intensive Care, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany

    Wiebke Schubert

  5. Department of Orthopaedic and Trauma Surgery, Luzerner Kantonsspital, Spitalstrasse, 6000, Luzern 16, Switzerland

    Matthias Knobe

  6. Section of Trauma- and Reconstructive Surgery, Department of Orthopaedics, Trauma- and Reconstructive Surgery, University Hospital Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany

    Matthias Aurich

Authors
  1. Kajetan Klos
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  2. Mark Lenz
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  3. Gunther O. Hofmann
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  6. Klaus Edgar Roth
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  7. Paul Simons
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  8. Matthias Aurich
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Corresponding author

Correspondence to Matthias Aurich.

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Conflict of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

Ethical Approval

The study has been approved by the local ethics committee of the Medical Faculty at the University of Jena, Germany, and was performed in accordance with the 1964 Declaration of Helsinki and the German Data Protection Act.

Ethical Standard Statement

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Informed Consent

Written informed consent for scientific investigations was given by all donors during their life time at the Institute of Anatomy, University Hospital Jena (Germany).

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Klos, K., Lenz, M., Hofmann, G.O. et al. The Correction Potential of the Lateral Release of the Hallux Valgus: A Comparative Anatomical Study of Minimally Invasive Versus Open Surgical Technique Using a Dorsal Approach. JOIO 56, 887–894 (2022). https://doi.org/10.1007/s43465-021-00575-3

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  • DOI: https://doi.org/10.1007/s43465-021-00575-3

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