A Radiologic Triangle Sign for Percutaneous Adductor Tendon Release (PATR): Cadaveric Study and Case Series

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Surgery
• Radiology

Background:

• Hallux valgus correction often combines osteotomies and soft tissue procedures.
• Maintaining sesamoid position and long-term correction are key goals.
• The association between a radiolucent sign and percutaneous adductor tendon release (PATR) requires investigation.

Purpose of the Study:

• To determine the radiologic association between a specific sign and full PATR.
• To evaluate the intra- and interobserver reliability of identifying this sign.
• To assess the utility of the sign in confirming PATR and capsule release.

Main Methods:

• A cadaveric study involving PATR and dissection was performed.
• A prospective observational study of 39 feet with hallux valgus treated with PATR and osteotomies.
• Radioscopic assessment for a radiolucent sign and a "triangle sign" by two observers.

Main Results:

• A radioscopic radiolucent sign was observed in 100% of cadavers and patients.
• A triangle-shaped image, termed the "triangle sign," was identified in 75% of cases.
• High intra- and interobserver reliability was found for these observations.

Conclusions:

• The "triangle sign" may serve as a valuable intraoperative indicator for PATR.
• This sign can help confirm the release of the latero-plantar capsule during percutaneous procedures.
• The findings support the use of the "triangle sign" for diagnostic criteria development.