Shortening, Percutaneous, Intra-articular, Chevron Osteotomy for the Treatment of Hallux Rigidus: An Anatomical Feasibility and Risk Assessment in Cadavers

Background: Hallux rigidus is a degenerative condition affecting the first metatarsophalangeal joint. Depending on symptoms, treatment options for symptomatic hallux rigidus include joint resection (such as arthrodesis or arthroplasty) or joint-preserving procedures (like cheilectomy or osteotomies). We present a shortening percutaneous, intra-articular, chevron osteotomy (S-PeICO) technique, which is a modification of the percutaneous intra-articular chevron osteotomy (PeICO) technique previously used to treat hallux valgus. The purpose is to evaluate iatrogenic neurovascular and tendon damage, as well as the accuracy of the osteotomy, including angulation and completion. Methods: Twelve fresh-frozen below-the-knee cadaveric specimens were used in this study and diagnosed with Coughlin grade I to III hallux rigidus and mild hallux valgus. To evaluate the procedure's safety, the following data were collected: (1) distance between portal 1 and dorsomedial digital nerve, (2) distance between portal 2 and the medial border of the extensor hallucis longus tendon, (3) distance between portal 2 and the dorsomedial digital nerve, (4) distance between portal 2 and the extensor hallucis capsularis, (5) distance between portal 1 and the metatarsophalangeal joint, and (6) distance between portal 2 and the metatarsophalangeal joint. Additionally, the angulation and completion of the osteotomy in the sagittal plane were evaluated. Results: No significant iatrogenic injuries were detected. The occurrence of minor lesions was 16.6% (2 specimens): one showed a 50% extensor hallucis brevis lesion, and another experienced a complete rupture of the extensor hallucis capsularis tendon. The smallest average distances were observed between portal 1 and dorsomedial digital nerve (3.5 mm) and portal 2 and extensor hallucis capsularis (1.37 mm). Conclusion: This cadaveric study suggests that S-PeICO is anatomically feasible when performed by experienced surgeons, but narrow safety margins and the potential of tendon lesions should be considered.