Purpose: Bipolar osteotomy of the first metatarsal with lateral release of the first metatarsophalangeal joint was performed in 19 cases of hallux valgus. The distal metatarsal surface was misaligned in all cases (increased DMMA). The purpose of our work was to evaluate outcome after Schnepp bipolar osteotomy.

Material and methods: The series included eleven women and three men who underwent the procedure between 1992 and 2001. All patients were reviewed retrospectively by the same clinician. Mean patient age was 56 years. Before surgery, mean values were: metatarsophalangeal valgus 39.6°, metatarsal varus 17.8°, and DMMA 21.1°. Mean foot opening measured preoperatively was 30°.

Results: The Groulier criteria, taking into consideration correction of the deformity, static disorders and function were assessed at mean follow-up of three years. Radiographically mean metatarsophalangeal valgus was 20.7°, metatarsal varus 10.3°, and DMMA 5.3°. The metatarsal span was 23°. The metatarsophalangeal joint was congruent and free of any sign of degeneration in 52%. Overall outcome was excellent or good in 57.5%, fair in 32% and poor in 10.5%.

Discussion: These results are rather modest but were obtained in a series of patients with severe hallux valgus. Bipolar osteotomy enables simultaneous correction of the phalangeal valgus, the metatarsal varus, and the increased DMMA, an advantage not obtained with any other procedure. Indications would include patients with increased DMMA > 15° or major metatarsal varus. Our series show that poor results can be observed in the event of incongruent joints, signs of osteoarthritic degeneration, or revision surgery.

Conclusion: Bipolar osteotomy of the first metatarsal remains indicated for the treatment of severe hallux valgus with increased DMMA. Metatarsophalanygeal arthrodesis should be reserved as a salvage procedure for non congruent or degenerated joints.

Purpose: Arthroscopic tenotomy of the long head of the biceps brachial is indicated for pain relief in the treatment of unrepairable tears of the rotator cuff. The purpose of our study was to evaluate clinical and radiological outcome.

Material and methods: This retrospective study included 38 patients (21 women and 17 men) mean age 65 years (44–78) who presented rotator cuff tears that could not be repaired by suture. These patients underwent arthroscopic tenotomy associated with acromioplasty in eight cases. Preoperative imaging included arthroscan and standard radiograms to assess retraction of the supraspinatus stump and fatty degeneration. The clinical outcome was assessed with the Constant score and search for loss of biceps force (estimated in comparision of an age- and gender-matched cohort). Modifications of the subarcomial height and the stage of joint degeneration were assessed on AP radiograms (standing and reclining position).

Results: Mean follow-up was 31 months. There were no complications related to the operation. The overall constant score improved 19 points from 39 to 58 (pain +7 and motion +6.1 increased most). The activity score improved 6 points. Active joint motion in antepulsion, abduction, and lateral rotation (elbow to body) increased 36.5°, 13.1° and 20.8° respectively. The sub acromial height decreased very little (from 7.4 mm preoperatively to 7.4 mm postoperatively). We observed a 37% decrease in arm force in flexion/supination on the operated side (6.05 kg vs 9.65 kg). Subjectively, 85% of the patients were very satisfied or satisfied, 10% were disappointed and 2.5% were discontent. For 88% of the patients the decision for surgical intervention was wise.

Discussion: Tenotomy of the long head of the brachial biceps is effective for pain relief and consequently joint motion. It is a technically simple procedure which does not accelerate degeneration of the excentered joint, at the follow-up considered. It does however reduce flexion force of the arm.