Percutaneous calcaneal sliding osteotomy with the rising sun technique

Calcaneal slide osteotomies represent a well-established component in the surgical treatment of joint-preserving hind foot corrections. The percutaneous technique aims to minimize the surgical morbidity and maximize surgical efficiency. There is a consensus that percutaneous calcaneal sliding osteotomy (PCSO), using a low-speed and hightorque burr, is generally performed in four steps corresponding to the four quadrants of the cross-section of the calcaneal tuber. We present a technique that allows a more efficient osteotomy by cutting the far cortex in one step using standard percutaneous equipment. The aim of this study is to present preliminary results and the surgical technique of a modification for percutaneous calcaneal sliding osteotomy.

Between June 2016 and March 2023, a total of 101 percutaneous calcaneal slide osteotomies were performed using the Rising Sun Technique. Prospective clinical and radiologic evaluation was completed for 70/101 cases (69.3%). Complications were classified according to the modified Clavien-Dindo-Sink Classification (CDS I-III). For the last 25 cases, additional information on surgery duration and use of fluoroscopy was available. The results of two surgeons (S1, S2) with different MIS experiences were compared to determine surgical proficiency.

The mean follow-up was 36 months (range 12-73 months). In 46 cases the underlying deformity was a planovalgus and in 24 a cavovarus deformity. In total, there were 5/70 (7.1%) surgery-related complications, three cases needed revision surgery: 2 patients required superficial surgical wound revision for disturbed wound healing, 1 patient requested screw removal due to discomfort related to the hardware after 15 months. The mean surgery duration for both surgeons combined was 19.6 min, and the average number of fluoroscopies was 20.2.

Compared to traditional open calcaneal slide osteotomies, PCSO helps to reduce softtissue morbidity and may result in fewer surgery-related complications. The Rising Sun procedure of PCSO represents a safe and easy-to-perform alternative to the traditional 4-quadrants technique in the percutaneous correction of hindfoot malalignment. Our prospective case series showed a low rate of complications and reproducible surgery time and use of fluoroscopy.