Discussion
ROM loss, inappropriate sesamoid
RECURRENCE
According to our study, the HVA and IMA in both groups returned to normal angles postoperatively. After 12 months of follow-up, the HVA had significantly changed in group L compared with group U, and recurrence of the HV deformity occurred in 4 patients in group L and 1 patient in group U. Compared with the inverted L-shaped capsulorrhaphy, the modified U-shaped capsulorrhaphy is less likely to result in a loss of HVA and help prevent the recurrence of HVA. Normal activity of the first MTP joint is one of the main objectives of HV surgery. In our study, the mean ROM of the first MTP joint was 53.3 ± 11.9 degrees at the 1-year follow-up in group U and 47.5 ± 11.8 degrees in group L. The degrees of ROM after 1 year in group U were better than those in group L. This result suggests that compared with inverted L-shaped capsulorrhaphy, modified U-shaped capsulorrhaphy is less likely to result in ROM loss in the first MTP joint.In our study, compared with inverted L-shaped capsulorrhaphy, modified U-shaped capsulorrhaphy could maintain the HVA better after 1 year of follow-up. The result could be explained by the fact that after the lateral soft tissue is released, the modified U-shaped capsulorrhaphy technique can shorten the extended medial collateral ligament (MCL), tighten the capsule, and then maintain the balance of the first MTP joint. Another study comparing clinical and radiographic differences between longitudinal capsulorrhaphy and inverted L-type capsulorrhaphy in patients diagnosed with HV showed that inverted L-type capsulorrhaphy was more effective in correcting the HVA [Schneider [There was 1 case of recurrence in group U and 4 of the patients from group L at the 1-year follow-up. HV recurrence can result from insufficient lateral release, inappropriate sesamoid realignment, or poor medial capsule repair, so lateral and medial soft tissue imbalance is the common reason of recurrence [There are also some limitations to this study. First, when evaluating the ROM of the first MTP joint, which was taken while moving the first MTP joint from maximum plantar flexion to maximum dorsiflexion, we did not distinguish dorsiflexion and plantar flexion movement of the first MTP joint. Second, the sample size was small, and the follow-up time was short term. A larger cohort and a longer follow-up are required to evaluate the results verifiably.
