Arthroscopic Interpositional Arthroplasty of the Second Metatarsophalangeal Joint

Abstract

Painful degenerative diseases of the second metatarsophalangeal joint are frequently progressive and difficult to treat. Surgical options for the degenerated second metatarsophalangeal joint include joint debridement and synovectomy, drilling and microfracture, core decompression, dorsal closing-wedge metatarsal osteotomies, joint arthroplasty (implant or interpositional), elevation of the depressed articular fragment and bone graft, distraction arthroplasty, osteochondral plug transplantation, osteochondral distal metatarsal allograft reconstruction, and resection arthroplasty (phalangeal base or metatarsal head). This technical note describes the arthroscopic approach of interpositional arthroplasty of the second metatarsophalangeal joint using the extensor digitorum brevis tendon. It is indicated in adult patients with extensive involvement of the metatarsal head cartilage, especially when cartilage degeneration of the proximal phalanx is also present. It is contraindicated if there is significant bone loss of the metatarsal head or the extensor digitorum brevis tendon is flimsy.

Interpositional Arthroplasty With Extensor Digitorum Brevis Tendon in Freiberg Disease

“…9,12,13,20 Known complications in patients with osteotomy include fixation failure and metatarsalgia. 1,23,28 In a study by Ikoma et al, 13 13 patients with Freiberg disease had extraarticular osteotomy, and after a follow-up period of a mean 17 months, dorsiflexion was seen to have increased from a mean of 37.2° preoperatively to 73.6°. In the current study, dorsiflexion was determined to have increased from a mean of 38.1° preoperatively to 55.3° at the final follow-up examination.…”

“…An arthroscopic technique of interpositional arthroplasty with the EDB tendon has been described. 22,23 Although the long-term follow-up results of the arthroscopic technique are not fully known, arthroscopic interpositional arthroplasty is not easy to perform, and the learning curve can be long. In addition, Liao et al 21 published a single case presentation in which interpositional arthroplasty of the palmaris longus tendon was used for Freiberg disease.…”

“…5,6,18,21,33 Studies have also reported surgical treatment with the extensor digitorum brevis (EDB) tendon arthroscopically. 22,23…”

“…5,6,18,21,33 Studies have also reported surgical treatment with the extensor digitorum brevis (EDB) tendon arthroscopically. 22,23 Describing a new interpositional arthroplasty technique using the EDB tendon, Özkan et al 26 published the early results of this technique in 2008. As it is not always possible to reshape the joint surface, there are insufficient data related to the long-term results of interpositional arthroplasty, which has been seen to provide good early results in patients with advanced-stage Freiberg disease.…”

Arthroscopic Dorsal Closing-Wedge Osteotomy of Metatarsal Head for Management of Freiberg Infraction

“…Osteotomy improves pain and function in terms of shortening the metatarsal length and restoring the metatarsal head's sphericity and metatarsophalangeal joint congruency 6, 12, 13. In advanced disease, open or arthroscopic salvage procedures including debridement, removal of the loose bodies, synovectomy, drilling of the metatarsal head, distraction arthroplasty, interpositional arthroplasty, and resection arthroplasty have been proposed 2, 5, 14, 15, 16, 17…”