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Transarticular Lateral Release Versus Percutaneous Lateral Release for Hallux Valgus

Primary Purpose

Hallux Valgus

Status
Not yet recruiting
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Distal soft tissue procedure with TALR
Distal soft tissue procedure with PCLR
Sponsored by
Taipei Veterans General Hospital, Taiwan
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hallux Valgus focused on measuring Hallux valgus, Distal soft tissue procedure, Transarticular lateral release (TALR), Percutaneous lateral release (PCLR), Minimally invasive surgery

Eligibility Criteria

20 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Age equal or greater than 20 years
  • Hallux valgus angle (HVA) equal or greater than 20 degrees
  • Persistent symptoms after failed conservative treatment
  • Receiving DMCO for HV

Exclusion Criteria:

  • Underlying rheumatoid or other inflammatory arthritis
  • Hallux rigidus
  • Recurrent hallux valgus after previous surgery
  • First tarsometatarsal hypermobility
  • A positive intraoperative stress test for lateral soft tissue release

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Active Comparator

    Active Comparator

    Arm Label

    Transarticular lateral release (TALR)

    Percutaneous lateral release (PCLR)

    Arm Description

    TALR The first toe is pulled distally for access into the lateral aspect of first MTPJ. A No.15 beaver blade is advanced from the medial incision laterally to divide the lateral capsule vertically and adductor hallucis tendon. Same intraoperative stress test is performed and recorded under fluoroscope to confirm correction.

    PCLR A 0.5 cm stab wound is made at lateral aspect of first MTPJ. A No. 15 beaver blade is advanced into the lateral side of MTPJ with a quarter of the blade inside the joint and verified with fluoroscope. The blade is turned laterally to face the adductor hallucis tendon. The adductor tendon is divided with lateral movement of the blade and varus manipulation of proximal phalanx. A click is heard as adequate release of adductor hallucis tendon. Same intraoperative stress test is performed and recorded under fluoroscope to confirm correction.

    Outcomes

    Primary Outcome Measures

    hallux valgus angle (HVA)(degrees)
    weightbearing dorsoplantar radiograph, angle between proximal phalanx and 1st metatarsal
    hallux valgus angle (HVA)(degrees)
    weightbearing dorsoplantar radiograph, angle between proximal phalanx and 1st metatarsal
    hallux valgus angle (HVA)(degrees)
    weightbearing dorsoplantar radiograph, angle between proximal phalanx and 1st metatarsal
    hallux valgus angle (HVA)(degrees)
    weightbearing dorsoplantar radiograph, angle between proximal phalanx and 1st metatarsal
    hallux valgus angle (HVA)(degrees)
    weightbearing dorsoplantar radiograph, angle between proximal phalanx and 1st metatarsal
    hallux valgus angle (HVA)(degrees)
    weightbearing dorsoplantar radiograph, angle between proximal phalanx and 1st metatarsal
    hallux valgus angle (HVA)(degrees)
    weightbearing dorsoplantar radiograph, angle between proximal phalanx and 1st metatarsal
    intermetatarsal angle (IMA) 1-2 (degrees)
    weightbearing dorsoplantar radiograph, angle between 1st metatarsal and 2nd metatarsal
    intermetatarsal angle (IMA) 1-2 (degrees)
    weightbearing dorsoplantar radiograph, angle between 1st metatarsal and 2nd metatarsal
    intermetatarsal angle (IMA) 1-2 (degrees)
    weightbearing dorsoplantar radiograph, angle between 1st metatarsal and 2nd metatarsal
    intermetatarsal angle (IMA) 1-2 (degrees)
    weightbearing dorsoplantar radiograph, angle between 1st metatarsal and 2nd metatarsal
    intermetatarsal angle (IMA) 1-2 (degrees)
    weightbearing dorsoplantar radiograph, angle between 1st metatarsal and 2nd metatarsal
    intermetatarsal angle (IMA) 1-2 (degrees)
    weightbearing dorsoplantar radiograph, angle between 1st metatarsal and 2nd metatarsal
    intermetatarsal angle (IMA) 1-2 (degrees)
    weightbearing dorsoplantar radiograph, angle between 1st metatarsal and 2nd metatarsal
    sesamoid position
    weightbearing dorsoplantar radiograph, the location of the medial sesamoid with progressive lateral subluxation from grade one to seven according to the classification system of Hardy and Clapham
    sesamoid position
    weightbearing dorsoplantar radiograph, the location of the medial sesamoid with progressive lateral subluxation from grade one to seven according to the classification system of Hardy and Clapham
    sesamoid position
    weightbearing dorsoplantar radiograph, the location of the medial sesamoid with progressive lateral subluxation from grade one to seven according to the classification system of Hardy and Clapham
    sesamoid position
    weightbearing dorsoplantar radiograph, the location of the medial sesamoid with progressive lateral subluxation from grade one to seven according to the classification system of Hardy and Clapham
    sesamoid position
    weightbearing dorsoplantar radiograph, the location of the medial sesamoid with progressive lateral subluxation from grade one to seven according to the classification system of Hardy and Clapham
    sesamoid position
    weightbearing dorsoplantar radiograph, the location of the medial sesamoid with progressive lateral subluxation from grade one to seven according to the classification system of Hardy and Clapham
    sesamoid position
    weightbearing dorsoplantar radiograph, the location of the medial sesamoid with progressive lateral subluxation from grade one to seven according to the classification system of Hardy and Clapham
    visual analogue scale (VAS) for pain
    pain score, (0-10, the lower the better)
    visual analogue scale (VAS) for pain
    pain score, (0-10, the lower the better)
    visual analogue scale (VAS) for pain
    pain score, (0-10, the lower the better)
    visual analogue scale (VAS) for pain
    pain score, (0-10, the lower the better)
    visual analogue scale (VAS) for pain
    pain score, (0-10, the lower the better)
    hallux-metatarsophalangeal-interphalangeal scale of American Orthopaedic Foot Ankle Society (AOFAS)
    functional score, 0-100, the higher the better
    hallux-metatarsophalangeal-interphalangeal scale of American Orthopaedic Foot Ankle Society (AOFAS)
    functional score, 0-100, the higher the better
    hallux-metatarsophalangeal-interphalangeal scale of American Orthopaedic Foot Ankle Society (AOFAS)
    functional score, 0-100, the higher the better
    hallux-metatarsophalangeal-interphalangeal scale of American Orthopaedic Foot Ankle Society (AOFAS)
    functional score, 0-100, the higher the better
    hallux-metatarsophalangeal-interphalangeal scale of American Orthopaedic Foot Ankle Society (AOFAS)
    functional score, 0-100, the higher the better

    Secondary Outcome Measures

    rate of osteonecrosis of first metatarsal head
    postoperative complications
    rate of osteonecrosis of first metatarsal head
    postoperative complications
    rate of osteonecrosis of first metatarsal head
    postoperative complications
    rate of numbness of hallux
    postoperative complication
    rate of numbness of hallux
    postoperative complication
    rate of numbness of hallux
    postoperative complication
    rate of infection
    postoperative complication
    rate of infection
    postoperative complication
    rate of infection
    postoperative complication
    rate of first MTPJ arthritis
    postoperative complication
    rate of first MTPJ arthritis
    postoperative complication
    rate of first MTPJ arthritis
    postoperative complication
    rate of recurrent hallux valgus
    postoperative complication, hallux valgus angle equal or greater than 20 degrees
    rate of recurrent hallux valgus
    postoperative complication, hallux valgus angle equal or greater than 20 degrees
    rate of recurrent hallux valgus
    postoperative complication, hallux valgus angle equal or greater than 20 degrees
    rate of hallux varus
    postoperative complication
    rate of hallux varus
    postoperative complication
    rate of hallux varus
    postoperative complication
    rate of reoperations
    postoperative complication
    rate of reoperations
    postoperative complication
    rate of reoperations
    postoperative complication

    Full Information

    First Posted
    July 19, 2020
    Last Updated
    October 29, 2020
    Sponsor
    Taipei Veterans General Hospital, Taiwan
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    1. Study Identification

    Unique Protocol Identification Number
    NCT04614675
    Brief Title
    Transarticular Lateral Release Versus Percutaneous Lateral Release for Hallux Valgus
    Official Title
    Transarticular Lateral Release Versus Percutaneous Lateral Release in Combination With Distal Metatarsal Chevron Osteotomy for Hallux Valgus -A Prospective Randomized Controlled Trial-
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    October 2020
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    January 1, 2021 (Anticipated)
    Primary Completion Date
    December 31, 2024 (Anticipated)
    Study Completion Date
    December 31, 2024 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Taipei Veterans General Hospital, Taiwan

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    background Hallux valgus (HV) is a common forefoot disorder in need of surgical intervention after failed conservative treatment. Surgical treatment of HV generally includes different kinds of osteotomy in combination with different distal soft tissue procedures (DSTP). Commonly used DSTP are open first-web lateral release, transarticular lateral release (TALR), and percutaneous lateral release (PCLR). In some studies, TALR showed similar surgical outcomes with open first-web space lateral release. Besides, PCLR has been described with satisfactory outcomes. TALR and PCLR are gaining popularity due to their less invasive approach and potential in combination with a distal metatarsal Chevron osteotomy (DMCO). Currently, there is no study comparing the surgical results between TALR and PCLR for surgical reconstruction of HV. Aim The aim of this prospective randomized trial is to compare the surgical outcomes of TALR versus PCLR, both in combination of DMCO, for the treatment of HV. Our hypothesis is that TALR would achieve a better surgical outcomes than PCLR.
    Detailed Description
    This study will be conducted from January, 2021 to December, 2024. A total of 140 participants are included with 70 participants in each group. Participants are allocated to TALR or PCLR group before index surgery according to a computer-generated randomization list. For all patients, after regional nerve block and adequate sedation, intraoperative stress test is performed for flexibility of first metatarsophalangeal joint (MTPJ).6 The test is confirmed with dorsoplantar fluoroscopy. Only the cases with negative results (passive correction is not possible) are included. Then, a medial incision of 2.5-cm is made at distal metatarsal head and a reverse L-shaped medial capsulotomy is made followed by TALR or PCLR. After TALR or PCLR, medial bunionectomy is performed. DMCO is made with the apex at distal metatarsal neck and angle of 60 to 90 degrees. The metatarsal head is laterally moved and fixed with one or 2 oblique headless compression screws. Postoperative followup The patients are followed up at two weeks for removal of stitches, then 1-month, 2-month, 3-month, 6-months, 1-year, and annually after 1 year for radiographic , functional assessments, and evaluation of complications. Power analysis for patient number With the assumption of mean HVA are 10 degrees for TALR group and 15 degrees for PCLR group at final followup, and a standard deviation of 8 degrees for both groups, the calculated effect size d is 0.625. In order to achieve the α error probability of 0.05 and power of 0.95, 68 participants in each group are necessary with a total of 136 participants in this study. Statistical analysis In the comparisons between TALR and PCLR groups, the independent two samples t-test and the Mann-Whitney test are performed for normal and non-normal distributed data respectively, and the Fisher's exact test is performed for categorical data. P-values less than 0.05 is considered to be statistical significant. The statistical analyses are performed by using SPSS 25.0 statistics software (SPSS Inc, Chicago, USA). Clinical relevance Compare the differences of surgical outcomes between TALR and PCLR. These results could offer valuable information for foot and ankle surgeon. If PCLR is not adequate to achieve satisfactory outcomes, the minimally invasive surgery using PCLR for HV is not recommended.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Hallux Valgus
    Keywords
    Hallux valgus, Distal soft tissue procedure, Transarticular lateral release (TALR), Percutaneous lateral release (PCLR), Minimally invasive surgery

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Not Applicable
    Interventional Study Model
    Parallel Assignment
    Masking
    None (Open Label)
    Allocation
    Randomized
    Enrollment
    140 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Transarticular lateral release (TALR)
    Arm Type
    Active Comparator
    Arm Description
    TALR The first toe is pulled distally for access into the lateral aspect of first MTPJ. A No.15 beaver blade is advanced from the medial incision laterally to divide the lateral capsule vertically and adductor hallucis tendon. Same intraoperative stress test is performed and recorded under fluoroscope to confirm correction.
    Arm Title
    Percutaneous lateral release (PCLR)
    Arm Type
    Active Comparator
    Arm Description
    PCLR A 0.5 cm stab wound is made at lateral aspect of first MTPJ. A No. 15 beaver blade is advanced into the lateral side of MTPJ with a quarter of the blade inside the joint and verified with fluoroscope. The blade is turned laterally to face the adductor hallucis tendon. The adductor tendon is divided with lateral movement of the blade and varus manipulation of proximal phalanx. A click is heard as adequate release of adductor hallucis tendon. Same intraoperative stress test is performed and recorded under fluoroscope to confirm correction.
    Intervention Type
    Procedure
    Intervention Name(s)
    Distal soft tissue procedure with TALR
    Intervention Description
    TALR group: Transarticular lateral release as the distal soft tissue procedure
    Intervention Type
    Procedure
    Intervention Name(s)
    Distal soft tissue procedure with PCLR
    Intervention Description
    PCLR: Percutaneous soft tissue procedures as the distal soft tissue procedure
    Primary Outcome Measure Information:
    Title
    hallux valgus angle (HVA)(degrees)
    Description
    weightbearing dorsoplantar radiograph, angle between proximal phalanx and 1st metatarsal
    Time Frame
    postoperative 1-month
    Title
    hallux valgus angle (HVA)(degrees)
    Description
    weightbearing dorsoplantar radiograph, angle between proximal phalanx and 1st metatarsal
    Time Frame
    postoperative 2-month
    Title
    hallux valgus angle (HVA)(degrees)
    Description
    weightbearing dorsoplantar radiograph, angle between proximal phalanx and 1st metatarsal
    Time Frame
    postoperative 3-month
    Title
    hallux valgus angle (HVA)(degrees)
    Description
    weightbearing dorsoplantar radiograph, angle between proximal phalanx and 1st metatarsal
    Time Frame
    postoperative 6-month
    Title
    hallux valgus angle (HVA)(degrees)
    Description
    weightbearing dorsoplantar radiograph, angle between proximal phalanx and 1st metatarsal
    Time Frame
    postoperative 12-month
    Title
    hallux valgus angle (HVA)(degrees)
    Description
    weightbearing dorsoplantar radiograph, angle between proximal phalanx and 1st metatarsal
    Time Frame
    postoperative 24-month
    Title
    hallux valgus angle (HVA)(degrees)
    Description
    weightbearing dorsoplantar radiograph, angle between proximal phalanx and 1st metatarsal
    Time Frame
    postoperative 36-month
    Title
    intermetatarsal angle (IMA) 1-2 (degrees)
    Description
    weightbearing dorsoplantar radiograph, angle between 1st metatarsal and 2nd metatarsal
    Time Frame
    postoperative 1-month
    Title
    intermetatarsal angle (IMA) 1-2 (degrees)
    Description
    weightbearing dorsoplantar radiograph, angle between 1st metatarsal and 2nd metatarsal
    Time Frame
    postoperative 2-month
    Title
    intermetatarsal angle (IMA) 1-2 (degrees)
    Description
    weightbearing dorsoplantar radiograph, angle between 1st metatarsal and 2nd metatarsal
    Time Frame
    postoperative 3-month
    Title
    intermetatarsal angle (IMA) 1-2 (degrees)
    Description
    weightbearing dorsoplantar radiograph, angle between 1st metatarsal and 2nd metatarsal
    Time Frame
    postoperative 6-month
    Title
    intermetatarsal angle (IMA) 1-2 (degrees)
    Description
    weightbearing dorsoplantar radiograph, angle between 1st metatarsal and 2nd metatarsal
    Time Frame
    postoperative 12-month
    Title
    intermetatarsal angle (IMA) 1-2 (degrees)
    Description
    weightbearing dorsoplantar radiograph, angle between 1st metatarsal and 2nd metatarsal
    Time Frame
    postoperative 24-month
    Title
    intermetatarsal angle (IMA) 1-2 (degrees)
    Description
    weightbearing dorsoplantar radiograph, angle between 1st metatarsal and 2nd metatarsal
    Time Frame
    postoperative 36-month
    Title
    sesamoid position
    Description
    weightbearing dorsoplantar radiograph, the location of the medial sesamoid with progressive lateral subluxation from grade one to seven according to the classification system of Hardy and Clapham
    Time Frame
    postoperative 1-month
    Title
    sesamoid position
    Description
    weightbearing dorsoplantar radiograph, the location of the medial sesamoid with progressive lateral subluxation from grade one to seven according to the classification system of Hardy and Clapham
    Time Frame
    postoperative 2-month
    Title
    sesamoid position
    Description
    weightbearing dorsoplantar radiograph, the location of the medial sesamoid with progressive lateral subluxation from grade one to seven according to the classification system of Hardy and Clapham
    Time Frame
    postoperative 3-month
    Title
    sesamoid position
    Description
    weightbearing dorsoplantar radiograph, the location of the medial sesamoid with progressive lateral subluxation from grade one to seven according to the classification system of Hardy and Clapham
    Time Frame
    postoperative 6-month
    Title
    sesamoid position
    Description
    weightbearing dorsoplantar radiograph, the location of the medial sesamoid with progressive lateral subluxation from grade one to seven according to the classification system of Hardy and Clapham
    Time Frame
    postoperative 12-month
    Title
    sesamoid position
    Description
    weightbearing dorsoplantar radiograph, the location of the medial sesamoid with progressive lateral subluxation from grade one to seven according to the classification system of Hardy and Clapham
    Time Frame
    postoperative 24-month
    Title
    sesamoid position
    Description
    weightbearing dorsoplantar radiograph, the location of the medial sesamoid with progressive lateral subluxation from grade one to seven according to the classification system of Hardy and Clapham
    Time Frame
    postoperative 36-month
    Title
    visual analogue scale (VAS) for pain
    Description
    pain score, (0-10, the lower the better)
    Time Frame
    postoperative 3-months
    Title
    visual analogue scale (VAS) for pain
    Description
    pain score, (0-10, the lower the better)
    Time Frame
    postoperative 6-months
    Title
    visual analogue scale (VAS) for pain
    Description
    pain score, (0-10, the lower the better)
    Time Frame
    postoperative 12-months
    Title
    visual analogue scale (VAS) for pain
    Description
    pain score, (0-10, the lower the better)
    Time Frame
    postoperative 24-months
    Title
    visual analogue scale (VAS) for pain
    Description
    pain score, (0-10, the lower the better)
    Time Frame
    postoperative 36-months
    Title
    hallux-metatarsophalangeal-interphalangeal scale of American Orthopaedic Foot Ankle Society (AOFAS)
    Description
    functional score, 0-100, the higher the better
    Time Frame
    postoperative 3-months
    Title
    hallux-metatarsophalangeal-interphalangeal scale of American Orthopaedic Foot Ankle Society (AOFAS)
    Description
    functional score, 0-100, the higher the better
    Time Frame
    postoperative 6-months
    Title
    hallux-metatarsophalangeal-interphalangeal scale of American Orthopaedic Foot Ankle Society (AOFAS)
    Description
    functional score, 0-100, the higher the better
    Time Frame
    postoperative 12-months
    Title
    hallux-metatarsophalangeal-interphalangeal scale of American Orthopaedic Foot Ankle Society (AOFAS)
    Description
    functional score, 0-100, the higher the better
    Time Frame
    postoperative 24-months
    Title
    hallux-metatarsophalangeal-interphalangeal scale of American Orthopaedic Foot Ankle Society (AOFAS)
    Description
    functional score, 0-100, the higher the better
    Time Frame
    postoperative 36-months
    Secondary Outcome Measure Information:
    Title
    rate of osteonecrosis of first metatarsal head
    Description
    postoperative complications
    Time Frame
    12-month
    Title
    rate of osteonecrosis of first metatarsal head
    Description
    postoperative complications
    Time Frame
    24-month
    Title
    rate of osteonecrosis of first metatarsal head
    Description
    postoperative complications
    Time Frame
    36-month
    Title
    rate of numbness of hallux
    Description
    postoperative complication
    Time Frame
    12-month
    Title
    rate of numbness of hallux
    Description
    postoperative complication
    Time Frame
    24-month
    Title
    rate of numbness of hallux
    Description
    postoperative complication
    Time Frame
    36-month
    Title
    rate of infection
    Description
    postoperative complication
    Time Frame
    12-month
    Title
    rate of infection
    Description
    postoperative complication
    Time Frame
    24-month
    Title
    rate of infection
    Description
    postoperative complication
    Time Frame
    36-month
    Title
    rate of first MTPJ arthritis
    Description
    postoperative complication
    Time Frame
    12-month
    Title
    rate of first MTPJ arthritis
    Description
    postoperative complication
    Time Frame
    24-month
    Title
    rate of first MTPJ arthritis
    Description
    postoperative complication
    Time Frame
    36-month
    Title
    rate of recurrent hallux valgus
    Description
    postoperative complication, hallux valgus angle equal or greater than 20 degrees
    Time Frame
    12-month
    Title
    rate of recurrent hallux valgus
    Description
    postoperative complication, hallux valgus angle equal or greater than 20 degrees
    Time Frame
    24-month
    Title
    rate of recurrent hallux valgus
    Description
    postoperative complication, hallux valgus angle equal or greater than 20 degrees
    Time Frame
    36-month
    Title
    rate of hallux varus
    Description
    postoperative complication
    Time Frame
    12-month
    Title
    rate of hallux varus
    Description
    postoperative complication
    Time Frame
    24-month
    Title
    rate of hallux varus
    Description
    postoperative complication
    Time Frame
    36-month
    Title
    rate of reoperations
    Description
    postoperative complication
    Time Frame
    12-month
    Title
    rate of reoperations
    Description
    postoperative complication
    Time Frame
    24-month
    Title
    rate of reoperations
    Description
    postoperative complication
    Time Frame
    36-month

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    20 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Age equal or greater than 20 years Hallux valgus angle (HVA) equal or greater than 20 degrees Persistent symptoms after failed conservative treatment Receiving DMCO for HV Exclusion Criteria: Underlying rheumatoid or other inflammatory arthritis Hallux rigidus Recurrent hallux valgus after previous surgery First tarsometatarsal hypermobility A positive intraoperative stress test for lateral soft tissue release
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Chao-Ching Chiang, MD
    Phone
    +886-2-28757557
    Ext
    140
    Email
    1966chiang@gmail.com
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Chao-Ching Chiang, MD
    Organizational Affiliation
    Taipei Veterans General Hospital, Taiwan
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No
    Citations:
    PubMed Identifier
    26152873
    Citation
    Wagner E, Ortiz C, Figueroa F, Vela O, Wagner P, Gould JS. Role of a Limited Transarticular Release in Severe Hallux Valgus Correction. Foot Ankle Int. 2015 Nov;36(11):1322-9. doi: 10.1177/1071100715593082. Epub 2015 Jul 7.
    Results Reference
    background
    PubMed Identifier
    25628283
    Citation
    Lee KB, Cho NY, Park HW, Seon JK, Lee SH. A comparison of proximal and distal Chevron osteotomy, both with lateral soft-tissue release, for moderate to severe hallux valgus in patients undergoing simultaneous bilateral correction: a prospective randomised controlled trial. Bone Joint J. 2015 Feb;97-B(2):202-7. doi: 10.1302/0301-620X.97B2.34449.
    Results Reference
    background
    PubMed Identifier
    23632675
    Citation
    Park CH, Jang JH, Lee SH, Lee WC. A comparison of proximal and distal chevron osteotomy for the correction of moderate hallux valgus deformity. Bone Joint J. 2013 May;95-B(5):649-56. doi: 10.1302/0301-620X.95B5.30181.
    Results Reference
    background
    PubMed Identifier
    24196470
    Citation
    Park YB, Lee KB, Kim SK, Seon JK, Lee JY. Comparison of distal soft-tissue procedures combined with a distal chevron osteotomy for moderate to severe hallux valgus: first web-space versus transarticular approach. J Bone Joint Surg Am. 2013 Nov 6;95(21):e158. doi: 10.2106/JBJS.L.01017.
    Results Reference
    background
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    Citation
    Ahn JY, Lee HS, Chun H, Kim JS, Seo DK, Choi YR, Kim SW. Comparison of open lateral release and transarticular lateral release in distal chevron metatarsal osteotomy for hallux valgus correction. Int Orthop. 2013 Sep;37(9):1781-7. doi: 10.1007/s00264-013-2023-1. Epub 2013 Aug 6.
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    de Las Heras-Romero J, Lledo-Alvarez AM, Andres-Grau J, Picazo-Marin F, Moreno-Sanchez JF, Hernandez-Torralba M. A new minimally extended distal Chevron osteotomy (MEDCO) with percutaneous soft tissue release (PSTR) for treatment of moderate hallux valgus. Foot (Edinb). 2019 Sep;40:27-33. doi: 10.1016/j.foot.2019.04.001. Epub 2019 Apr 4.
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    Citation
    Lucas y Hernandez J, Golano P, Roshan-Zamir S, Darcel V, Chauveaux D, Laffenetre O. Treatment of moderate hallux valgus by percutaneous, extra-articular reverse-L Chevron (PERC) osteotomy. Bone Joint J. 2016 Mar;98-B(3):365-73. doi: 10.1302/0301-620X.98B3.35666.
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    Bock P, Kluger R, Kristen KH, Mittlbock M, Schuh R, Trnka HJ. The Scarf Osteotomy with Minimally Invasive Lateral Release for Treatment of Hallux Valgus Deformity: Intermediate and Long-Term Results. J Bone Joint Surg Am. 2015 Aug 5;97(15):1238-45. doi: 10.2106/JBJS.N.00971.
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    Kim HN, Suh DH, Hwang PS, Yu SO, Park YW. Role of intraoperative varus stress test for lateral soft tissue release during chevron bunion procedure. Foot Ankle Int. 2011 Apr;32(4):362-7. doi: 10.3113/FAI.2011.0362.
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    Transarticular Lateral Release Versus Percutaneous Lateral Release for Hallux Valgus

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