Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study.
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2023-05
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Abstract
Introduction
Instability/collapse of the medial column has been associated with many conditions, particularly progressive collapsing foot deformity (PCFD), hallux valgus (HV), and midfoot arthritis (MA). Restoration of first ray length and sagittal plane alignment to restore the foot tripod is essential when treating these deformities. This study aimed to assess early results, healing, and complication rate of a distraction dorsal opening plantarflexion wedge allograft first tarsometatarsal joint fusion (LapiCotton Procedure) in patients with collapse/instability of the medial column.Methods
In this prospective cohort study, we included PCFD, HV, and MA patients that underwent a LapiCotton procedure. Fusion site healing was defined by > 50% bone bridging in both interfaces between allograft wedge and host bone using weight-bearing computed tomography (WBCT) after 3 months. First ray collapse radiographic correction and minor and major complications (deep dehiscence, deep infection, and reoperation) were assessed.Results
A total of 22 patients (22 feet) were included (11 PCFD, 6 MA, and 5 of HV patients). Mean follow-up was 5.9 months (range 3-12) and median allograft size was 8 mm (range 5-19 mm). Bone healing was observed in 91% of cases. Two minor complications (9%, both superficial dehiscence) and one major complication (4.5%, deep infection) were observed. Statistically significant improvement of the sagittal plane talus-first metatarsal angle was observed, with mean improvement of 9.4° (95% CI 6.7-12.1°; p < 0.0001).Conclusion
In this prospective cohort study of 22 patients treated with the LapiCotton procedure for medial longitudinal arch collapse/instability, we observed a low complication rate (9% minor, 4.5% major), high healing rate after 3 months (91%), one clinically stable radiographic non-union (4.5%) and one unstable non-union (4.5%) needing reoperation. Our results demonstrate promising initial results for LapiCotton technique in treating collapse of the medial longitudinal arch in patients with PCFD, MA and HV deformities. Long-term results are needed to confirm these promising results.Level of evidence
Level II, prospective cohort study.Type
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de Cesar Netto, Cesar, Amanda Ehret, Jennifer Walt, Rogerio Marcio Kajimura Chinelati, Kevin Dibbern, Kevin Dibbern, Kepler Alencar Mendes de Carvalho, Tutku Erim Tazegul, et al. (2023). Early results and complication rate of the LapiCotton procedure in the treatment of medial longitudinal arch collapse: a prospective cohort study. Archives of orthopaedic and trauma surgery, 143(5). pp. 2283–2295. 10.1007/s00402-022-04399-0 Retrieved from https://hdl.handle.net/10161/27415.
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Cesar de Cesar Netto
The desire to explore, research, and understand things in great detail has been the driving force throughout my career. This passion drew me to Foot and Ankle, a subspecialty expanding in orthopedic knowledge with many unsolved mysteries. After completing my Medical School, Orthopedic Residency, and Foot and Ankle Fellowship at the renowned University of Sao Paulo, ranked number one in Latin America for several years, and after five years of clinical practice in Brazil, this desire to explore and understand also brought me to the United States. As part of my Ph.D. program with the University of Sao Paulo, I joined as a visiting scientist and research fellow for Dr. Lew Schon at the traditional MedStar Union Memorial Hospital in Baltimore-MD, where I developed an animal model of induced Achilles tendinopathy.
As a practicing physician in Brazil, I achieved multiple goals in my early career. Academics have been a large component of my practice, allowing me to participate in young physicians' education and challenge my understanding of orthopedic fundamentals. As the elected Chief of Orthopaedic Residents from 2011 to 2013, I presented 245 lectures to orthopedic surgeons and in multidisciplinary conferences. My practice as an orthopedic surgeon in Sao Paulo allowed me to combine the Brazilian enthusiasm for soccer, serving as the team physician and Foot and Ankle advisor for the professional soccer team Sport Club Corinthians Paulista for almost five years.
As a Foot and Ankle surgeon, I constantly sought to confront the unsolved questions in our orthopedic practices. During my Ph.D. studies with the University of Sao Paulo, I aimed to maximize my research experience and clinical exposure. During my time in Maryland, I have engaged in multiple research projects, collaborating with MedStar Union Memorial and Johns Hopkins University to evaluate and clinically implement innovative imaging techniques, including weight-bearing CT, dynamic CT, 3D MRI, and metal artifact reduction sequence (MARS) MRI.
I was also amazed by the American medical system's resources that create opportunities for motivated physicians to excel in clinical work, educational teaching endeavors, and research investigations. While this balance requires dedication and precise time management, I have been fortunate to work with a variety of mentors who demonstrated to me how great it could be to practice in the US. With that in mind, I ended up deciding to pursue the Academic Pathway of the ABOS Certification. I have completed a total of three Orthopedic Foot and Ankle Fellowships in the US. The first was at the University of Alabama at Birmingham (UAB), the second at the Hospital for Special Surgery (HSS) in New York City, and the third and final at MedStar Union Memorial Hospital in Baltimore-MD. It was a long but very pleasant and rewarding pathway that allowed me to grow as a person, as a clinician, and as a surgeon while being fortunate to create lifetime bonds with several mentors. Once I was done with my fellowships, my objective was to combine my unique background with my innovative and instructive training and apply the acquired knowledge as an Academic Assistant Professor at the Department of Orthopedics of the Carver College of Medicine at the University of Iowa.
The almost four years in Iowa City have been a blast! The leadership of the Orthopedic Department entirely and constantly supported me, and together, we achieved a lot in a relatively short amount of time. I utilized my academic start-up grant to acquire the first Weight-Bearing CT scanner in the Country that allows the hip, knee, foot, and ankle to be scanned under load simultaneously. With the scanner, I founded and served as the Director of the University of Iowa Orthopedic Functional Imaging Research Laboratory (OFIRL), which rapidly achieved an established, recognized position in the research and orthopedic foot and ankle community. I also had the unique opportunity to care for the State of Iowa community suffering from orthopedic foot and ankle problems, always excelling in providing high-quality and passionate clinical and surgical care. I’ll be forever grateful to my leadership, partners, and colleagues in Iowa City, as well as my patients, who gave me the utmost opportunity to care for them.
As an Associate Professor in the Department of Orthopedics at Duke University, I hope to contribute further to the American society and North Carolina Community, taking excellent care of patients, teaching and mentoring medical students, residents, and fellows, and helping the orthopedic foot and ankle surgery research to excel.
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