PURPOSE OF THE STUDYIn this study, we retrospectively reviewed a consecutive case series of first metatarsophalangeal (MTP) joint arthroscopies performed in our department over a span of six years. This study aimed to evaluate the efficacy and safety of arthroscopic treatment for various first MTP joint pathologies. MATERIAL AND METHODSA total of 36 patients that underwent first MTP joint arthroscopy between January 2014 and December 2019 were reviewed. The mean age at the time of surgery was 38.3 years (range, 14-65), with no gender predominance (19 males). All arthroscopies were performed by a single surgeon using a 2.7 mm arthroscope with a 30° viewing angle as well as other standard instruments with a diameter equal to or smaller than 3.5 mm. Postoperative results were assessed by a satisfaction questionnaire obtained during the telephone interview. For patients with sesamoid bone pathology ability to return to sports activities was also evaluated. RESULTSThe far most common indication, in even twenty-nine patients, was hallux rigidus, five patients were treated for nonunion of sesamoid bone fracture, one patient had an osteochondral defect of the first metatarsal head and one was treated due to the development of arthrofibrosis following the open corrective procedure of hallux valgus. The mean follow-up was 31.2 months. Thirty-four patients responded to the satisfaction questionnaire. Thirty patients (88.2%) were either satisfied or very satisfied with the procedure and thirty-one (91.2%) of them stated that they would undergo the same procedure again. The satisfaction rate for patients with early stages of hallux rigidus (grade 1 and 2) was 90.4%. Only one patient in this group (2.8%) required open revision surgery due to recurrence of pain and joint stiffness. All patients with nonunion of sesamoid bone fracture were very satisfied with the procedure, and three out of four patients (75%) who were also competitive athletes resumed their sports activity at the same or improved level after the arthroscopy. Regarding arthroscopy-related complications we observed four cases (11.1%) of iatrogenic injury to dorsal sensory nerves of the great toe, resulting in only one permanent sensory impairment. DISCUSSIONConsidering the high satisfaction rate and low rate of complications in our study, as well as those published in the literature, we can suggest that arthroscopy of the first MTP joint is a safe and effective procedure. CONCLUSIONSArthroscopy of the first MTP joint certainly has a place in the treatment of some pathological conditions of the first MTP joint, and in our opinion, it should be first-line surgical therapy for the initial stages of hallux rigidus and sesamoid bone pathology.

Introduction: Pigmented villonodular synovitis (PVNS) is a rare and benign proliferative lesion affecting synovial lining of joints, bursae, and tendon sheaths. Depending on the extent of synovial involvement, two forms are distinguished, diffuse, and localized. Intra-articular localized form of PVNS (LPVNS) presents as a nodular, well circumscribed, pedunculated, or sessile soft-tissue mass. Case Presentation: We report a case of an unusual localization of LPVNS in posterior ankle recess in a 42-year-old male with concomitant anterior ankle impingement syndrome. To address both the posterior and the anterior ankle disorders the patient was treated with combined two-portal endoscopic hindfoot approach and anterior ankle arthroscopy within the same operative session. The hindfoot endoscopy encompassed complete removal of the localized mass, partial synovectomy of the area at the base of the lesion, removal of os trigonum, and a loose body impinged in the interval between tibia and fibula. The anterior ankle arthroscopy included removal of the osteophytes from the anterior distal tibia and dorsal talus. Patient continued his normal daily and sporting activities without any restrictions and no recurrence of LPVNS 2 years after the surgery. Conclusion: PVNS is an important clinical entity that should always be thought of as a differential diagnosis when treating patients with ankle disorders. Hindfoot endoscopy, when performed by an experienced ankle surgeon, is a safe and effective procedure for LPVNS of the posterior ankle recess, when deemed amenable to complete resection.

Sažetak. Artroskopija prvoga metatarzofalangealnog zgloba (1. MTF zglob) danas je neizostavna metoda kirurškog zbrinjavanja ozljeda i njihovih posljedica te oštećenja koja zahvaćaju taj zglob. Prednosti artroskopske kirurgije 1. MTF zgloba u odnosu prema klasičnoj otvorenoj metodi operacijskog liječenja višestruke su. U prvome redu artroskopija nam omogućuje izvanredan prikaz unutarzglobnih struktura i time detaljan pregled čitavog zgloba te potpuno izvođenje zahvata bez otvaranja zgloba. Nadalje, morbiditet je znatno niži, rehabilitacija brža, a brži je i povratak svakodnevnim aktivnostima. Osnovni preduvjeti za uspješnu primjenu artroskopije 1. MTF zgloba jesu pažljivo prijeoperacijsko planiranje, izvanredno dobro poznavanje regionalne anatomije, striktno praćenje pravila izvođenja zahvata, dobra tehnika te iskusan operater. Osnovnim indikacijama za artroskopiju 1. MTF zgloba danas se smatraju početni stadiji haluksa rigidusa, osteohondritis disekans glave 1. metatarzalne kosti, sinovitisi različite etiologije te patološki procesi sezamskih kostiju palca stopala. U ovom članku opisujemo indikacije, tehniku, komplikacije, kao i perspektivu artroskopije 1. MTF zgloba, uz detaljan pregled suvremenih literaturnih podataka.