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Arthroscopic Arthrodesis of the First Metatarsophalangeal Joint in Hallux Varus

ABSTRACT: Hallux varus deformity most commonly occurs as a complication of bunion surgery. Surgical option depends on the underlying cause, flexibility of the deformity, and presence of osteoarthritis of the first metatarsophalangeal joint. Joint-preserving surgery including medial soft tissue release, metatarsal osteotomy, and tendon transfer can be considered in flexible deformity without degeneration of the first metatarsophalangeal joint. First metatarsophalangeal arthrodesis is indicated in cases of inflammatory arthritis, avascular necrosis, osteoarthritis, neuromuscular disorder, or failed previous hallux varus corrective surgery. The purpose of this technical note is to describe the technique of arthroscopic arthrodesis of the first metatarsophalangeal joint to correct hallux varus deformity. It has the potential advantages of less surgical trauma, preservation of blood supply, less postoperative pain, and better cosmetic results. Technique Video Video 1 Arthroscopic arthrodesis of the first metatarsophalangeal joint in hallux varus of the right foot. The patient is in supine position with the legs spread. The abductor hallucis tendon and medial capsule of the first metatarsophalangeal joint is released via the proximal plantar medial incision. With the medial portal as the viewing portal and the dorsolateral portal as the working portal, the articular cartilage of the base of proximal phalanx and the metatarsal head is removed with an arthroscopic shaver and the subchondral bone is microfractured with an arthroscopic awl. Tourniquet is released to observe for bleeding from the microfracture holes. The first metatarsophalangeal joint is then reduced to 20° dorsiflexion and fixed with two 4.0 mm cannulated screws under fluoroscopic guide.

SUBMITTER: Li C

PROVIDER: S-EPMC8626559 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundHallux rigidus (HR) is a common pathology of the first metatarsophalangeal (MTP) joint causing pain and stiffness. However, severity of symptoms and radiographic findings are not always concordant. A novel flexibility device, which measures the mobility of the MTP joint through its arc of motion, has been validated. This study compares flexibility in patients before and after cheilectomy (with or without proximal phalanx osteotomy) for HR.MethodsThis is a single-center study of adult patients with HR who were indicated for cheilectomy or cheilectomy and Moberg (dorsiflexion closing wedge) osteotomy of the proximal phalanx based on symptoms and radiographs from 2013 to 2015. Pre- and postoperatively, patients underwent testing with a validated flexibility protocol to generate flexibility curves. Parameters included early and late flexibility, laxity torque, and laxity angle. Patients completed Foot and Ankle Outcomes Scores (FAOS) pre- and postoperatively. Twelve operative patients underwent preoperative testing, with 9 completing postoperative testing (mean age, 53.0 years; 67% female; mean 2.8-year follow-up).ResultsPatients had significant improvements in early sitting and standing flexibility, sitting and standing laxity angles, standing laxity torque, and both sitting and standing maximum dorsiflexion after surgery (all P < .05). While preoperative early flexibility, laxity angle, and maximum dorsiflexion all differed significantly between patients and controls (P < .015), postoperative early flexibility was similar to controls (P > .279). FAOS scores for pain, symptoms, sport, and quality improved significantly after surgery.ConclusionSurgical treatment with cheilectomy was associated with significant improvements in nearly all flexibility parameters for sitting and standing positions. However, most postoperative flexibility parameters did not improve to the level of normal controls. Regardless, patients still experienced significant improvements in outcomes. This study demonstrated that surgical correction is associated with significant biomechanical and clinical results. The flexibility device can be used in further studies to assess outcomes after other HR procedures.Level of evidenceLevel II, prospective comparative study.

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Arthroscopic Arthrodesis of the First Metatarsophalangeal Joint in Hallux Varus

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