Effect of percutaneous chevron and Akin osteotomies on measured first-ray joint pressures: An exploratory cadaveric study.

Abstract

Background: Percutaneous chevron and Akin osteotomies may alter first-ray mechanics, but their effects on pressure within the first tarsometatarsal and first metatarsophalangeal joints are unknown.

Purpose: To assess immediate changes in measured intra-articular pressure within these joints after percutaneous chevron and Akin (PECA) osteotomies.

Study design: Exploratory paired cadaveric biomechanical study.

Methods: Sixteen feet from 8 cadaveric donors were tested. Pressure transducer was inserted fluoroscopically into the first tarsometatarsal and first metatarsophalangeal joints. For each joint, hallux position, and loading condition, three consecutive pressure readings were obtained and averaged. Pre- versus post-PECA and rest-versus-manual-loading comparisons were analyzed using paired Wilcoxon signed-rank tests, with Holm adjustment across 40 comparisons. A donor-level sensitivity analysis was performed to address bilateral specimens.

Results: No PECA-related change in measured intra-articular pressure at either joint remained statistically significant after Holm adjustment for multiple comparisons. At the first tarsometatarsal joint, all mean paired pre- versus post-PECA changes had 95% confidence intervals that included zero. A donor-level sensitivity analysis accounting for bilateral feet did not alter the overall interpretation.

Conclusion: Under the tested conditions, this exploratory study did not detect a multiplicity-adjusted PECA-related change in measured intra-articular pressure at either joint. These findings do not establish equivalence, cartilage contact pressure, joint contact area, first-ray stability, or biomechanical safety.