Modified Endoscopic Distal Soft Tissue Procedure With Medial Metatarsosesamoid Ligament and Intermetatarsal Ligament Augmentation

Hallux valgus is one of the most common foot and ankle conditions faced by orthopaedic surgeons. Surgical correction of hallux valgus is frequently indicated for symptomatic deformity. Recently, the endoscopic technique of hallux valgus correction has been reported, which is basically an endoscopic approach to the classic distal soft tissue procedure. In this technical note, the technical details of the modified endoscopic distal soft tissue procedure with medial metatarsosesamoid ligament and intermetatarsal ligament augmentation is described. In this modified technique, the intact intermetatarsal ligament, plantar capsule of the first metatarsophalangeal joint (including the sesamoid apparatus), and medial metatarsosesamoid ligament form a soft tissue envelop that can wrap around the first metatarsal head to stabilize the first metatarsal in the reduced position. Video 1 Modified endoscopic lateral soft tissue procedure with medial metatarsosesamoid ligament and intermetatarsal ligament augmentation of the left foot. The patient is in the supine position with the legs spread. The plantar portal is the viewing portal, and the toe web portal is the working portal. The adductor hallucis and lateral capsuloligamentous complex are released. Endoscopic bunionectomy is performed with the proximal bunion portal used as the viewing portal and the distal bunion portal used as the working portal. Two meniscal repair needles are inserted via the dorsal incision to the lateral side of the medial sesamoid. These bring back two PDS suture loops. The suture loops serve as suture retrievers and bring the minitape to the lateral side of the medial sesamoid. The minitape is passed through a bone tunnel at the first metatarsal neck, wrapped around the second metatarsal neck, and returned to the proximal bunion portal. The intermetatarsal space is closed up and transfixed by a basal intermetatarsal screw. The minitape is tensioned and fixed to the bone tunnel by a SwiveLock anchor.