Transarticular Distal Soft-Tissue Release with an Arthroscopic Blade for Hallux Valgus Correction

Abstract

The few reported anatomic studies have proved the inconsistency of distal soft-tissue release for hallux valgus correction with both the open (dorsal) and transarticular approaches. Anatomic dissections were performed in 15 fresh-frozen human anatomic lower extremity specimens to evaluate the efficacy of the transarticular soft-tissue release utilizing an arthroscopic blade. The features of the arthroscopic blade, such as continuous cutting surface in all edges, increased length as compared with the No. 15 scalpel blade, and flexibility that permits bending without the likelihood of breakage, substantially increase its efficacy during the transarticular soft-tissue release, allowing for complete release of the lateral sesamoid ligament, lateral metatarsophalangeal capsule, and the adductor hallucis tendon insertion onto the proximal phalangeal base. Based on these observations, the authors recognized the inherent limitations of the transarticular approach for complete adductor release from the lateral sesamoid. Transarticular release including the lateral sesamoid ligament, lateral metatarsophalangeal capsule, and the adductor hallucis tendon insertion onto the proximal phalangeal base utilizing the arthroscopic blade is a versatile, reproducible, safe, and easy technique that should be expected to have decreased morbidity and improved cosmesis compared with the open approach.