Archives of Orthopaedic and Trauma Surgery

Published in:

Open Access 21-03-2022 | Computed Tomography | Orthopaedic Surgery

Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study

Authors: Cesar de Cesar Netto, Amanda Ehret, Jennifer Walt, Rogerio Marcio Kajimura Chinelati, Kevin Dibbern, Kepler Alencar Mendes de Carvalho, Tutku Erim Tazegul, Matthieu Lalevee, Nacime Salomão Barbachan Mansur

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 5/2023

Abstract

Introduction

Instability/collapse of the medial column has been associated with many conditions, particularly progressive collapsing foot deformity (PCFD), hallux valgus (HV), and midfoot arthritis (MA). Restoration of first ray length and sagittal plane alignment to restore the foot tripod is essential when treating these deformities. This study aimed to assess early results, healing, and complication rate of a distraction dorsal opening plantarflexion wedge allograft first tarsometatarsal joint fusion (LapiCotton Procedure) in patients with collapse/instability of the medial column.

Methods

In this prospective cohort study, we included PCFD, HV, and MA patients that underwent a LapiCotton procedure. Fusion site healing was defined by > 50% bone bridging in both interfaces between allograft wedge and host bone using weight-bearing computed tomography (WBCT) after 3 months. First ray collapse radiographic correction and minor and major complications (deep dehiscence, deep infection, and reoperation) were assessed.

Results

A total of 22 patients (22 feet) were included (11 PCFD, 6 MA, and 5 of HV patients). Mean follow-up was 5.9 months (range 3–12) and median allograft size was 8 mm (range 5–19 mm). Bone healing was observed in 91% of cases. Two minor complications (9%, both superficial dehiscence) and one major complication (4.5%, deep infection) were observed. Statistically significant improvement of the sagittal plane talus-first metatarsal angle was observed, with mean improvement of 9.4° (95% CI 6.7–12.1°; p < 0.0001).

Conclusion

In this prospective cohort study of 22 patients treated with the LapiCotton procedure for medial longitudinal arch collapse/instability, we observed a low complication rate (9% minor, 4.5% major), high healing rate after 3 months (91%), one clinically stable radiographic non-union (4.5%) and one unstable non-union (4.5%) needing reoperation. Our results demonstrate promising initial results for LapiCotton technique in treating collapse of the medial longitudinal arch in patients with PCFD, MA and HV deformities. Long-term results are needed to confirm these promising results.

Level of evidence

Level II, prospective cohort study.

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Title: Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study
Authors: Cesar de Cesar Netto
Amanda Ehret
Jennifer Walt
Rogerio Marcio Kajimura Chinelati
Kevin Dibbern
Kepler Alencar Mendes de Carvalho
Tutku Erim Tazegul
Matthieu Lalevee
Nacime Salomão Barbachan Mansur
Publication date: 21-03-2022
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
Hallux Valgus
Arthritis
Hallux Valgus
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 5/2023
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-022-04399-0

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Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study

Abstract

Introduction

Methods

Results

Conclusion

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