1. Stage II – Lateral Column Lengthening: Who? What? When? Where? Why?
AOFAS OLC Advanced Surgical Technique Course
San Diego, CA
March, 2017
Scott Ellis
Hospital for Special Surgery

2. Goals and Overview The Who? What? When? Where? Why?
Questions we should probably ask ourselves for every surgery.
Describe surgical technique (briefly): How?
Indicate when to perform surgery
How to avoid complications
Lateral foot overload (overcorrection)
Nounion

3. Who? Who described it? Who does it?
Evans: anterior calcaneal calcaneal osteotomy 1975
Calcaneovalgus feet
Who does it?
41% of AOFAS in 2003 (Pinney)
Perhaps more today?
Pediatric Orthopaedic Surgeons more commonly in isolation without heel slide

4. What?
Elongation of lateral side of foot, usually at anterior calcaneus or CC joint.
Evans, stepcut, or through CC joint
A way to correct forefoot abduction in flatfoot
May correct slightly arch or heel valgus

5. Evans: Where? Opening wedge osteotomy, anterior calcaneus
12 to 15 proximal to cc joint
Leave medial cortex?

6. When? Stage II b deformity
Flexible deformity
Significant forefoot abduction (>30% uncoverage)
Spring ligament compromise (superiomedial)
Good eversion potential after medial heel slide

7. How to Judge the Amount of Lengthening ?
ASSESSMENT in OR CRITICAL: avoid stiffness
Reduce TN abduction
Simulated Fluoro
Test passive eversion and stop before feels too tight
Trial wedges

8. Graft Size Between 4 and 8mm Less than 4mm More than 8mm
Probably don’t need LCL
More than 8mm
Risking lateral overload
Possible increase in nonunion

9. Why LCL? Corrects forefoot abduction Takes tension of spring ligament
Not solved by heel slide
Takes tension of spring ligament

10. Why not LCL?
Nonunion
Lateral overload
Subtalar subluxation

11. Other Pearls Use equations to guide amount of correction
Slightly overcorrect radiographically heel valgus
Slightly undercorrect forefoot abudction radiographically
Obsess yourself with eversion potential

12. Conclusions Important component of stage IIb reconstruction
Probably less important than heel alignment
Put in appropriate size graft, not too much
4 to 8mm
Correction
Assess intraop eversion potential
Simulated AP fluro correction
Preop incongruency angle