Burr to Bind-Risk of Tendon Injury during MIS Cheilectomy in a Cadaver Model

Research Type: Level 5 - Case report, Expert opinion, Personal observation Introduction/Purpose: Hallux rigidus (HR) is the most common arthritic condition in the foot and is commonly treated with cheilectomy. Minimally invasive surgery (MIS) cheilectomy offers quicker recovery but can pose a risk to nearby soft tissues, particularly the extensor hallucis longus (EHL) tendon. The purpose of this study was to evaluate the risk of EHL tendon injury during MIS cheilectomy in a cadaveric model based on burr type and first metatarsophalangeal joint (MTP). Methods: A total of 28 feet were studied, and EHL tendon injury was simulated using either a Shannon cutting or wedge burr with the 1st MTP joint in neutral or dorsiflexed positions. The rate of occurrence and time to tendon injury were recorded with logistic regression analysis used to evaluate predictors of tendon injury. Results: EHL tendon injuries occurred at a rate of 48.2%. The Shannon burr caused injuries in 22 out of 28 (78.6%) tendons, whereas the wedge burr caused injury in 5 out of 28 tendons (17.9%). Logistic regression identified that utilizing the Shannon burr against the EHL tendon with the 1st MTP joint in dorsiflexion was a significant risk factor (p = 0.0461) for tendon injury, while the wedge burr reduced tendon injury risk (p = 0.0118). Burr type significantly influenced time to injury (p < 0.001), but MTP position alone was not significant (p = 0.803). Conclusion: The Shannon burr has a greater risk of EHL tendon injury during MIS cheilectomy, especially with the 1st MTP joint dorsiflexed. The wedge burr has a significantly lower injury rate and a longer time to potential injury. MTP positioning alone had no significant effect. These findings highlight the importance of burr selection in reducing complications during MIS cheilectomy, with implications for improving surgical safety and outcomes.