Augmentation of the medial collateral ligament using suture tape reduces the recurrence after corrective surgery for severe hallux valgus

Tomoyuki Nakasa; Yasunari Ikuta; Junichi Sumii; Akinori Nekomoto; Shingo Kawabata; Andi Praja Wira Yudha Luthfi; Nobuo Adachi

doi:10.1016/j.jos.2023.07.010

Augmentation of the medial collateral ligament using suture tape reduces the recurrence after corrective surgery for severe hallux valgus

J Orthop Sci. 2023 Jul 29:S0949-2658(23)00199-9. doi: 10.1016/j.jos.2023.07.010. Online ahead of print.

Authors

Tomoyuki Nakasa¹, Yasunari Ikuta², Junichi Sumii², Akinori Nekomoto², Shingo Kawabata², Andi Praja Wira Yudha Luthfi³, Nobuo Adachi²

Affiliations

¹ Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan. Electronic address: tnakasa0@gmail.com.
² Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan.
³ Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan; Department of Orthopaedics and Traumatology, Bhayangkara Tk.I R. Said Sukanto Police Hospital, Jakarta, Indonesia.

PMID: 37524641
DOI: 10.1016/j.jos.2023.07.010

Abstract

Background: The severity of hallux valgus (HV) deformity is associated with recurrence after corrective surgery because of the degenerative change of the medial capsule including the medial collateral ligament (MCL) at the metatarsophalangeal joint. This study aimed to assess the effectiveness of the MCL augmentation using a suture tape anchor of the recurrence of HV and to evaluate the histological changes of the medial joint capsule in HV patients.

Methods: Thirty-four feet with severe hallux valgus were included and divided into 2 groups. Seventeen feet had the MCL reconstruction using suture tape anchor with a combination of the corrective osteotomy as the suture tape group (mean age, 64.0 years), and other seventeen feet had the corrective osteotomy without MCL reconstruction as the control group (mean age, 62.0 years). HV angle (HVA) and intermetatarsal angle (IMA) on the weight-bearing radiograms and the Japanese Society for Surgery of the Foot (JSSF) score in both groups were compared at the final follow-up. The medial capsule was harvested from other 20 feet with HV and the relationship between the severity of HV and the histological findings was analyzed.

Results: HVA, IMA, and JSSF scores in both groups were significantly improved from preoperatively to the final follow-up (P < 0.01). At the final follow-up, HVA in the suture tape group (9.2°) was significantly smaller than that in the control (15.4°) (P < 0.01). There were no significant differences in the IMA and the JSSF score at the final follow-up between both groups. Histological scores in HV with ≥40° HVA was significantly worse than those in <40°.

Conclusion: The medial joint capsule in severe HV deformity showed the degenerative change and the MCL reconstruction using suture tape combined with osteotomy provides a strong medial constraint to prevent the recurrence of the deformity in severe hallux valgus.

Level of clinical evidence: 3.

Keywords: Anchor; Hallux valgus; Medial collateral ligament; Recurrence; Suture tape.