{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:17:20Z","timestamp":1787019440352,"version":"build-2736575974"},"reference-count":13,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Orthopaedics"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The use of fourth-generation minimally invasive hallux valgus surgery with metaphyseal extra-articular transverse and Akin osteotomy, recently dubbed \u201cMETA,\u201d is a new generation of minimally invasive surgical (MIS) technique and a recent focus of foot and ankle orthopaedic literature associated with good functional outcomes and low complication rates. Literature in orthopaedic trauma has indicated that 2 or 3 neocortices on postoperative radiographs are associated with high likelihood of union. In this study, we conducted a retrospective analysis to investigate the time to bony union for patients undergoing fourth-generation MIS hallux valgus repair as well as the relationship between intraoperative degree of first-metatarsal displacement and time to bony union.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We retrospectively analyzed 217 consecutive patients with moderate to severe hallux valgus who underwent fourth-generation MIS first distal metatarsal and Akin osteotomy between 2020 and 2023 and were followed for up to 1\u2009year. Radiographic measurements included the scale of displacement between the proximal and distal portions of the first metatarsal as a percentage and the number of neocortical bridge formations at the osteotomy site. Postoperative weightbearing radiographs were recorded at 6\u2009weeks, 3\u2009months, 6\u2009months, and 1\u2009year to assess time to union and patient clinical outcomes. Two orthopaedic surgeons independently reviewed the radiographs to assess progression to bony union. Any discrepancy in analysis was resolved by a third-party clinician. Complete union was defined as the presence of at least 2 new cortical bridge formations on postoperative X-ray films. Patients were divided into 3 groups based on the percentage of shift on the first metatarsal head (\u226450%, 51%-75%, \u226576%) for the purpose of our analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Union (\u22652 cortices) was observed in 17%, 70%, and 90% of patients at 6\u2009weeks, 3\u2009months, and 6\u2009months, respectively. At final follow-up (mean 13\u2009\u00b1\u20096.9\u2009weeks), 92% achieved union. No significant differences in time to union were observed across metatarsal shift groups.<\/jats:p>\n                    <jats:p>Complications include 3 nonunions, 3 revisions, 16 cases that necessitated removal of hardware, 1 case of superficial wound infection, 1 case of deep wound infection, and 6 deformity recurrences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Time to union after META procedure typically occurred by 13\u2009weeks, independent of shift magnitude. Surgeons may consider \u22652 cortices and absence of symptoms as sufficient indicators for advancing weightbearing. These findings may assist in patient counseling and postoperative planning.<\/jats:p>\n                    <jats:p>\n                      <jats:bold>Level of Evidence:<\/jats:bold>\n                      Level IV, retrospective case series.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/24730114251343549","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T02:29:08Z","timestamp":1751941748000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Time to Radiographic Union Following Minimally Invasive META Procedure for Hallux Valgus"],"prefix":"10.1177","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-1608-6503","authenticated-orcid":false,"given":"Taylor","family":"Schnepp","sequence":"first","affiliation":[{"name":"Baptist Health Orthopedic Institute, Coral Gables, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Lorenzo","sequence":"additional","affiliation":[{"name":"Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chase","family":"Burzynski","sequence":"additional","affiliation":[{"name":"Nova Southeastern University School of Osteopathic Medicine, Fort Lauderdale, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Mirharooni","sequence":"additional","affiliation":[{"name":"Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wade","family":"Massey","sequence":"additional","affiliation":[{"name":"Baptist Health Orthopedic Institute, Coral Gables, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"San Giovanni","sequence":"additional","affiliation":[{"name":"Baptist Health Orthopedic Institute, Coral Gables, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher W.","family":"Hodgkins","sequence":"additional","affiliation":[{"name":"Baptist Health Orthopedic Institute, Coral Gables, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7149-8748","authenticated-orcid":false,"given":"Cary B.","family":"Chapman","sequence":"additional","affiliation":[{"name":"Baptist Health Orthopedic Institute, Coral Gables, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-200209000-00004"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.000000000004004"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/10711007231152491"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.20.01178"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jot.2023.10.009"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.4081\/ejtm.2022.10835"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hcl.2023.06.001"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.5704\/MOJ.1907.001"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjmilitary-2019-001375"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-021-04972-5"},{"key":"e_1_3_2_12_2","article-title":"Time to union as a measure of effectiveness","author":"Van Kollenburg J","year":"2012","unstructured":"Van Kollenburg J, Ring D. Time to union as a measure of effectiveness. Harv Orthop J. 2012;14:12-21. Published Online. http:\/\/www.orthojournalhms.org","journal-title":"Harv Orthop J"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.RVW.23.00223"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2021.09.008"}],"container-title":["Foot &amp; Ankle Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/24730114251343549","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/24730114251343549","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/24730114251343549","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T21:24:25Z","timestamp":1777411465000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/24730114251343549"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":13,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1177\/24730114251343549"],"URL":"https:\/\/doi.org\/10.1177\/24730114251343549","relation":{},"ISSN":["2473-0114","2473-0114"],"issn-type":[{"value":"2473-0114","type":"print"},{"value":"2473-0114","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7]]},"article-number":"24730114251343549"}}