Comparison of the Modified McBride Procedure and the Distal Chevron Osteotomy for Mild to Moderate Hallux Valgus.

Distal metatarsal osteotomy and the modified McBride procedure have each been used for the treatment of mild to moderate hallux valgus. However, few studies have compared the results of these 2 procedures for mild to moderate hallux valgus. The purpose of the present study was to compare the results of distal chevron osteotomy and the modified McBride procedure for treatment of mild to moderate hallux valgus according to the severity of the deformity. We analyzed the data from 45 patients (49.5%; 48 feet [49.0%]), who had undergone an isolated modified McBride procedure (McBride group), and 46 patients (50.5%; 50 feet [51.0%]), who had a distal chevron osteotomy (chevron group). We subdivided each group into those with mild and moderate deformity and compared the clinical and radiologic outcomes between the groups in relation to the severity of the deformity. The improvements in the American Orthopaedic Foot and Ankle Society scale score and the visual analog scale for pain were significantly better for the chevron group for both mild and moderate deformity. The chevron group experienced significantly greater correction in the hallux valgus angle and intermetatarsal angle for both mild and moderate deformity. The chevron group experienced a significantly greater decrease in the grade of sesamoid displacement for patients with moderate deformity. The McBride group had a greater risk of recurrence than did the chevron group for moderate deformity (odds ratio 14.00, 95% confidence interval 3.91 to 50.06, p < .001). The results of the present study have demonstrated the superiority of the distal chevron osteotomy over the modified McBride procedure for mild to moderate deformity. For patients with moderate deformity, the McBride group had a greater risk of hallux valgus recurrence than did the distal chevron group. Therefore, we recommend distal chevron osteotomy rather than a modified McBride procedure for the treatment of mild and moderate hallux valgus.

A Postaxial Polydactyly with a Partial Duplication of the Fifth Metatarsal Without a Supernumerary Digit. Is Excision of the Duplicated Metatarsal Necessary?

Postaxial polydactyly of the foot is one of the most common congenital malformations. Only a few cases of postaxial polydactyly with a partial duplication of the fifth metatarsal without a supernumerary digit have been reported, and both metatarsal heads were united to form a common joint with the proximal phalanx in all of those cases. We present a rare case of postaxial polydactyly with a partial duplication of the fifth metatarsal characterized by dual metatarsal heads and an extra proximal phalanx bud, without a supernumerary digit.

Is radiographic measurement of bony landmarks reliable for lateral meniscal sizing?

BACKGROUND: The accuracy of meniscal measurement methods is still in debate. HYPOTHESIS: The authors' protocol for radiologic measurements will provide reproducible bony landmarks, and this measurement method of the lateral tibial plateau will correlate with the actual anatomic value. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty-five samples of fresh lateral meniscus with attached proximal tibia were obtained during total knee arthroplasty. Each sample was obtained without damage to the meniscus and bony attachment sites. The inclusion criterion was mild to moderate osteoarthritis in patients with mechanical axis deviation of less than 15°. Knees with lateral compartment osteoarthritic change or injured or degenerated menisci were excluded. For the lateral tibial plateau length measurements, the radiographic beam was angled 10° caudally at neutral rotation, which allowed differentiation of the lateral plateau cortical margins from the medial plateau. The transition points were identified and used for length measurement. The values of length were then compared with the conventional Pollard method and the anatomic values. The width measurement was done according to Pollard's protocol. For each knee, the percentage deviation from the anatomic dimension was recorded. Intraobserver error and interobserver error were calculated. RESULTS: The deviation of the authors' radiographic length measurements from anatomic dimensions was 1.4 ± 1.1 mm. The deviation of Pollard's radiographic length measurements was 4.1 ± 2.0 mm. With respect to accuracy-which represents the frequency of measurements that fall within 10% of measurements-the accuracy of authors' length was 98%, whereas for Pollard's method it was 40%. There was a good correlation between anatomic meniscal dimensions and each radiologic plateau dimensions for lateral meniscal width (R(2) = .790) and the authors' lateral meniscal length (R(2) = .823) and fair correlation for Pollard's lateral meniscal length (R(2) = .660). The reliability of each radiologic measurement showed good reliability (intraclass correlation coefficients, .823 to .973). The authors tried to determine the best-fit equation for predicting meniscal size from Pollard's method of bone size, as follows: anatomic length = 0.52 × plateau length (according to Pollard's method) + 5.2, not as Pollard suggested (0.7 × Pollard's plateau length). Based on this equation-namely, the modified Pollard method-the percentage difference decreased, and the accuracy increased to 92%. CONCLUSION: Lateral meniscal length dimension can be accurately predicted from the authors' radiographic tibial plateau measurements. CLINICAL RELEVANCE: This study may provide valuable information in preoperative sizing of lateral meniscus in meniscal allograft transplantation.

Transpatellar approach in lateral meniscal allograft transplantation using the keyhole method: can we prevent graft extrusion?

PURPOSE: technique for guide wire placement during meniscal allograft transplantation (MAT) is usually based on the parapatellar approach that is not in the anatomical direction of meniscal horn bony insertions. Here, we present a surgical technique to achieve the correct anatomical position of the meniscal graft using the transpatellar approach. METHODS: a guide wire was introduced through the patellar tendon in the direction of the meniscal insertion sites passing the lateral tibial spine. The insertion plane of the guide wire was approximately at the medial aspect of the tibial tuberosity and slightly medial to the midplane of the patellar tendon. After confirmation with C-arm, the guide wire was cut at the level just beneath the patellar tendon. The knee was then brought to the extension position which lessened the tension of the patellar tendon and retracted it to the medial aspect to expose the end of the guide wire. Drilling and insertion of bone block was performed accordingly. RESULTS: eleven consecutive patients with total or near-total meniscectomy of the knee underwent MAT with the described technique. The mean extrusion taken on 1-year postoperative non-weight-bearing MRI was 1.6 mm (range 0.5-2.9 mm). None of the patients presented with symptoms requiring a secondary surgery at the time of review. CONCLUSION: the described technique focuses on achieving correct positioning of the tibia tunnel through the patellar tendon and tunnel reaming in the extended knee position via the mini-open parapatellar approach during lateral MAT. This "transpatellar approach" could be an effective method for anatomical placement of meniscal graft.

Peripheral nerve sheath tumor of the medial plantar nerve without tarsal tunnel syndrome: a case report.

UNLABELLED: Peripheral nerve sheath tumors are relatively uncommon soft tissue tumors, and the incidence of peripheral nerve sheath tumors localized to the plantar surface of the foot, without symptoms of tarsal tunnel syndrome, is even more rare. In this report, we present the rare case of a patient with a peripheral nerve sheath tumor originating from the medial plantar nerve in the plantar vault. The tumor was enucleated and fully excised under microscopic inspection using fine-tipped instrumentation, without en bloc resection of the associated nerve trunk. Surgeons should consider peripheral nerve sheath tumor as a cause of plantar foot pain, despite the rarity of this disorder. LEVEL OF CLINICAL EVIDENCE: 4.