Displacement Following Minimally Invasive vs Open Lateralizing Calcaneal Osteotomy: A Direct Comparison in a...

Area of Science:

• Orthopedic Surgery
• Foot and Ankle Surgery
• Surgical Techniques

Background:

• Minimally invasive surgery (MIS) is increasingly adopted for calcaneal osteotomy to reduce soft tissue complications.
• The efficacy of MIS lateral displacement calcaneal osteotomy (LDCO) in achieving comparable calcaneal translation to open techniques is not well-established.

Purpose of the Study:

• To compare the degree of lateral translation of the calcaneal tuberosity between MIS LDCO and open LDCO.
• To evaluate if MIS LDCO can achieve similar deformity correction to open LDCO.

Main Methods:

• A paired cadaveric study design was employed, with 16 feet from 8 donors randomized to undergo either open or MIS LDCO.
• Lateral translation was measured directly via a medial approach using a metric ruler.
• Statistical analysis included the Wilcoxon signed-rank test to compare the two techniques, with a clinically meaningful threshold defined as ≥5 mm of lateralization.

Main Results:

• The median lateralization was 5.0 mm for MIS LDCO and 7.5 mm for open LDCO.
• No statistically significant difference in lateral translation was detected between the MIS and open techniques (P = .14).
• A clinically relevant threshold of ≥5 mm was achieved in 4 of 8 MIS specimens compared to 2 of 8 open specimens, indicating less consistency with the MIS approach.

Conclusions:

• Both open and MIS LDCO achieve similar lateral translation of the calcaneal tuberosity, though MIS LDCO demonstrated less consistency in reaching the ≥5 mm threshold.
• Either approach is suitable for correcting mild-to-moderate hindfoot varus, with technique selection influenced by soft tissue and infection risk factors.
• MIS LDCO offers comparable deformity correction to open LDCO while potentially minimizing soft tissue morbidity.