ABSTRACT The objective of this study was to investigate potential benefit of a suture anchor-enhanced capsulorraphy in the early maintenance of correction in bunionectomies. We compared, retrospectively, in successive series, the loss of correction of the Hallux Valgus (HV) and inter- metatarsal (IM) angle, in those repaired with an L-shaped capsulorraphy enhanced with anchors to those without. Intraoperative and second week postoperative simulated weightbearing anterior posterior (AP) X-rays were used to evaluate results. By using only intraoperative and early postoperative X-rays, we should have effectively elimi- nated extraneous factors that might have influenced our results. A Total of 106 cases were investigated, 65 of which were repaired using anchors, the remaining 41 without. In the anchor group, 38 underwent a proximal metatarsal concentric shelf osteotomy (CSO)/modified McBride procedure, while the remaining 27 had a distal Chevron correction. In the without-anchor group, 21 had a CSO/modified McBride procedure while 20 underwent the Chevron procedure. In the without-anchor group, the average HV and IM loss of correction was 4.60° (range, -2 to 21°) and 0.6° (range, -1 to 9°) respectively. In the anchor group, the corresponding loss was 2.8° (range, -3 to 17°) and 0.6° (range, -2 to 14°) respectively. These results, when statistically analyzed, demonstrated that while the IM angle change was not statistically significant, the HV angle change was statistically significant, implying that the anchor plays a significant role in maintaining the sur- gical correction in both the distal Chevron and CSO/ modified McBride bunionectomies. INTRODUCTION Hallux Valgus was defined by Elmslie in 1926 as a lat- eral deviation of the big toe at the metatarsophalangeal joint; this deformity can be accompanied with joint sub- luxation, pronation, and attenuation of the medial soft tissue structures such as the joint capsule and the abductor hallucis tendon. 2 While there are a great many publications describing the bony procedures and their significance, 1,4,5,6 there is little documentation in the literature concerning the cap- sulorraphy and its importance in obtaining and main- taining the surgical correction. Silver, in 1923, described an operation involving a Y-shaped medial capsulorraphy but mentioned very lit- tle as to its significance in bunion correction. 7 Goldberg, et al. described the Teardrop Capsulectomy and capsu- lorraphy, subjectively describing its importance espe- cially in soft tissue procedures. 3 Other frequently used capsulorraphies include the “Leuticular”, “Dorsolinear”, and “Y-shaped”. We have long been concerned about early loss of cor- rection of the hallux valgus angle in the immediate post- operative period, defined as the time between comple- tion of the procedure in the operating room and the first dressing change at the one or two week interval. We are aware that the bunion correction may fail over time due to lack of biomechanical alignment correction and subsequent muscular imbalance, inappropriate shoe FOOT & ANKLE INTERNATIONAL Copyright © 2003 by the American Orthopaedic Foot & Ankle Society, Inc. Anchor Enhanced Capsulorraphy in Bunionectomies Using an L-shaped Capsulotomy John S. Gould, M.D.; Sheriff Ali, M.D.; Rachel Fowler, M.S., R.D. C.D.E.; Glenn S. Fleisig, Ph.D. Birmingham, AL 61 Corresponding Author: John S. Gould, M.D. Alabama Sports Medicine and Orthopaedic Center 1201 11th Avenue South, Suite 200 Birmingham, AL 35205 Phone: (205) 918-2126 Fax: (205) 939-4488 E-mail: gouldjs@aol.com Fig. 1: The medial sagittal incision for the distal Chevron procedure.