Osteochondritis Dissecans of the First Metatarsophalangeal Joint: Arthroscopy and Microfracture Technique

Background Osteochondrosis (OC) is a common developmental orthopedic disease affecting both humans and animals. Despite increasing recognition of this disease among children and adolescents, its pathogenesis is incompletely understood because clinical signs are often not apparent until lesions have progressed to end-stage, and examination of cadaveric early lesions is not feasible. In contrast, both naturally-occurring and surgically-induced animal models of disease have been extensively studied, most notably in horses and swine, species in which OC is recognized to have profound health and economic implications. The potential for a translational model of human OC has not been recognized in the existing human literature. Objective The purpose of this review is to highlight the similarities in signalment, predilection sites and clinical presentation of naturally-occurring OC in humans and animals and to propose a common pathogenesis for this condition across species. Study Design Review Methods The published human and veterinary literature for the various manifestations of OC was reviewed. Peer-reviewed original scientific articles and species-specific review articles accessible in PubMed (US National Library of Medicine) were eligible for inclusion. Results A broad range of similarities exists between OC affecting humans and animals, including predilection sites, clinical presentation, radiographic/MRI changes, and histological appearance of the end stage lesion, suggesting a shared pathogenesis across species. Conclusion This proposed shared pathogenesis for OC between species implies that naturally-occurring and surgically-induced models of OC in animals may be useful in determining risk factors and for testing new diagnostic and therapeutic interventions that can be used in humans.

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“…[96] OC also infrequently affects the shoulder, carpal, and hip joints of both humans and horses. [14, 97]…”

Section: Shared Aspects Of Human and Animal Osteochondrosismentioning

confidence: 99%

Articular osteochondrosis: a comparison of naturally-occurring human and animal disease

McCoy

Tóth

Dolvik

et al. 2013

Osteoarthritis and Cartilage

106

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“…7 Although some authors prefer a 2.7-mm arthroscope, we use a 1.9-mm arthroscope to maximize joint access while mitigating the potential for iatrogenic injury from passage of relatively large instruments. 8 A 30 arthroscope is used most commonly, but a 70 arthroscope may facilitate intra-articular visualization and should be available (Fig 8). In addition, a variety of small-joint instruments should always be on hand.…”

Section: Discussionmentioning

confidence: 99%

“…This technique is well established for treatment of OCLs in large joints, such as the ankle and knee; however, there are few reports of its use for lesions of the MTP-1 joint. 3,8,9 Microfracture of the MTP-1 joint can be technically challenging because of the small size of the joint and lesion (Table 2). In our experience, OCLs can be effectively debrided to a stable The outcomes of arthroscopy-based procedures of the MTP-1 joint are largely favorable; however, results are typically reported in series that consist of patients undergoing disparate procedures for heterogeneous pathologic processes.…”

Section: Discussionmentioning

confidence: 99%

“…A separate study reported good to excellent results in 3 of 4 patients undergoing arthroscopic debridement of MTP-1 joint OCLs. 2 Bojani c et al 8 reported favorable outcomes at 1 year in 2 patients who underwent arthroscopic OCL microfracture of the metatarsal. Most surgeons using arthroscopy-based techniques for the MTP-1 joint caution readers about the technical difficulty of MTP-1 joint arthroscopy; however, the consensus is that MTP-1 arthroscopy is a safe and effective alternative with the added benefits of less soft-tissue dissection, reduced scarring, and faster recovery.…”

Section: Discussionmentioning

confidence: 99%

“…Most surgeons using arthroscopy-based techniques for the MTP-1 joint caution readers about the technical difficulty of MTP-1 joint arthroscopy; however, the consensus is that MTP-1 arthroscopy is a safe and effective alternative with the added benefits of less soft-tissue dissection, reduced scarring, and faster recovery. [1][2][3]8,[10][11][12] The reported complications of MTP-1 joint arthroscopy in general and OCL treatment in particular are few. The most common complication is iatrogenic neurapraxia, typically transient, which is likely due to erroneous portal placement or instrument passage.…”

Section: Discussionmentioning

confidence: 99%

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First Metatarsophalangeal Joint Arthroscopy for Osteochondral Lesions

Sherman

Kern

Marcel

et al. 2016

Arthroscopy Techniques

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Small-joint arthroscopy has supplanted open procedures because it offers the potential for improvement in joint visualization, reduced scarring, and accelerated recovery. Despite these advantages, arthroscopy of the first metatarsophalangeal joint is not commonly performed and reports of its use are lacking. The reason for this is not clear but may be because of perceived technical complexity and poorly defined indications. In our experience, however, arthroscopy of the first metatarsophalangeal joint is a versatile procedure that facilitates treatment of many different pathologic processes through a minimally invasive approach with few complications. We present our technique for arthroscopic management of osteochondral lesions of the hallux.

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