Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint

Abstract

BackgroundAlthough arthroscopic surgical treatment of the first metatarsophalangeal (MTP) joint involves painful sesamoid excision, synovectomy, debridement, and partial cheilectomy, no gold standard treatment technique has been defined in the literature for hallux rigidus and focal osteochondral lesions. This study aimed to assess the arthroscopic treatment for early grade focal osteochondral lesions of the first MTP joint and to determine the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in a group of patients who failed conservative treatment.MethodsThis prospective study included 14 patients with hallux rigidus and focal osteochondral lesions of the first MTP joint who underwent surgery in 2014 and were followed on a regular basis thereafter.ResultsThe patients had mean preoperative VPS (visual pain score) and AOFAS (American Orthopedic Foot and ankle Society)-Hallux scores of 8.14 ± 0.86 SD and 48.64 ± 4.27, respectively; the corresponding postoperative values of both scores were 1.86 ± 0.66 SD and 87.00 ± 3.70. Both VPS and AOFAS-Hallux scores changed significantly.DiscussionIn this prospective study, we explored the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in patients with focal osteochondral lesions of the first MTP joint. Our results showed significant improvements in VPS and AOFAS scores with this treatment.ConclusionsAn arthroscopic microhole drill technique can be used with impressive functional scores and without any complications in patients who failed conservative therapy for hallux rigidus with focal chondral injury.

Evaluation of the clinical-radiographic results of patients undergoing arthroscopic metatarsal-phalangeal arthrodesis of the hallux

“…Forefoot endoscopic and arthroscopic procedures have been performed for almost 40 years (14) and, in the last 15 years, have been developed to perform or assist in the treatment of various pathological conditions, such as hallux valgus (9) , hallux varus (10) , osteochondral lesions of the 1st MTP (15) , and arthrodesis. Successive studies have shown safety and success in approaching these different lesions of the metatar salphalangeal joint of the hallux.…”

“Cartilage Injuries of the Foot: What We Do Not Know, We Fear . . .”

“…Nevertheless, cartilage lesions of the foot are profoundly disabling, characterized by a diminished quality of life and a substantial disruption of daily functioning. 4,6,7 This underscores the necessity of a more extensive and elaborate scientific understanding through the presently prepared Special Issue, emanating from diverse Centers of Excellence within the International Cartilage Regeneration & Joint Preservation Society (ICRS), aimed at delivering the soundest up-to-date evidence-based guidance to medical practitioners entrusted with the care of patients with cartilage lesions to the foot.…”

Metatarsophalangeal Joint Reconstruction Using Talar Osteochondral Allograft following a Failed Dorsal Cheilectomy

“…Osteochondral lesion of the first MTP joint in hallux rigidus requires additional consideration. Current arthroscopic treatments of osteochondral defects of the first MTP joint include sesamoid excision, synovectomy, debridement, and partial cheilectomy, which can be painful procedures [ 14 ]. Microhole drill and microfracture techniques are additional options; however, in general, marrow-inducing approaches have not been shown to sustain long-term benefits due to the inferior biomechanical properties of the fibrocartilage repair tissue [ 14 , 15 ].…”

“…Current arthroscopic treatments of osteochondral defects of the first MTP joint include sesamoid excision, synovectomy, debridement, and partial cheilectomy, which can be painful procedures [ 14 ]. Microhole drill and microfracture techniques are additional options; however, in general, marrow-inducing approaches have not been shown to sustain long-term benefits due to the inferior biomechanical properties of the fibrocartilage repair tissue [ 14 , 15 ]. Osteochondral autograft implantation is also used to treat osteochondral lesions, but subsequent pressure on the donor site can increase morbidity [ 15 , 16 ].…”