Chevron vs transverse cut comparison in minimally invasive hallux valgus correction. Does the osteotomy affect outcome?

T. Lewis, R. Ray, D. Gordon

Background: There has recently been a move to utilising distal transverse osteotomies (META) rather than chevron osteotomies (MICA) during minimally invasive hallux valgus surgery (MIS HV). The aim of this study is to investigate if there are any differences in union rates or clinical outcomes between these two techniques.

Methodology: A retrospective comparative analysis of a single surgeon research registry containing prospectively collected patient reported outcomes for patients undergoing MIS HV. Patients with minimum two year follow up were divided into two cohorts based on which osteotomy technique was used. Outcome measures were union rates and clinical outcomes (assessed using the Manchester-Oxford Foot Questionnaire, a validated outcome measure).

Results: Between 2014-2018, 292 feet underwent MICA and between 2019-2021 228 feet underwent META. The symptomatic delayed union rate was higher in the META cohort compared to the MICA cohort (4.4% vs 1.5%) but not statistically significant (p=0.07). The revision for non-union rate was also higher in the META cohort compared to the MICA cohort (2.6% vs 1.2%) but not statistically significant (p=0.30). There was no statistically significant difference between the two cohorts in any of the MOXFQ domains at final follow up (p>0.05).

Conclusion: There was a higher, but not statistically significant, rate of symptomatic delayed union and revision for non-union in patients undergoing MIS HV with a transverse osteotomy compared to those treated with a chevron osteotomy.