Allograft Tendon Interposition Arthroplasty of the Hallux Metatarsophalangeal Joint: A Technique Guide and Literature Review

Abstract

The "anchovy" interpositional arthroplasty technique can be used as a salvage option for failed hallux rigidus procedures. The operative technique utilized by the senior author is described. Careful soft-tissue handling, meticulous joint space and graft preparation, and interposition graft stabilization using a bone tunnel and suture anchors are unique aspects of this technique, which in the authors' experience have contributed to improved outcomes. Current literature regarding indications and outcomes is limited and controversial. The proposed benefits of soft-tissue interposition arthroplasty of the hallux metatarsophalangeal joint for patients with prior failed implant arthroplasty are improved pain scores and preservation of range of motion. Level of Evidence: Level V, technique guide.

Keller resection arthroplasty

“…With regard to interposition arthroplasty, despite the theoretical advantages of the modified technique, some authors did not find better outcomes compared with those of the traditional Keller technique (17) . In a clinical and radiological study, Watson et al (14) compared 22 feet treated with interposition arthroplasty with 30 feet subjected to the traditional Keller As for the Valenti technique, there are few studies published in the literature, but the scarce results published so far are very similar.…”

“…• Resection arthroplasty with capsular interposition (14) : the classical Keller technique is combined with the interposition of the dorsal capsule and the extensor hallucis brevis tendon.…”

Interpositional Arthroplasty of the First Metatarsophalangeal Joint with Bioresorbable Pldla Implant in the Treatment of Hallux Rigidus and Arthritic Hallux Valgus: A 9-Year Case Series Follow-Up

“…According to our results, we cannot compare our technique with the Brandeskeller procedure, yet it seems that there might not be similar problems with postoperative metatarsalgia or deformities with PLDLA implant. multiple graft techniques, including autogenous fascia lata, gracilis autograft, tendon allograft, amniotic membrane graft, collagenous tissue matrix, meniscal allograft, and synthetic hydrogel cartilage matrix, have all been described for mTP-1 interpositional arthroplasty with favorable outcomes (7,(21)(22)(23). Complications associated with the interpositional arthroplasty technique may include shortening of the first ray, lesser metatarsalgia, and weakness with hallux plantarflexion (24).…”

Summary Report of the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society’s Symposium on Targets for Osteoarthritis Research: Part 2: Treatment Options

“…17,18 Interpositional arthroplasty using soft tissue (such as tendon or autografts) may be an option to preserve the joint for patients with pain and grinding. 85 Another option for these patients is to replace the hemiphalanx and/or the hemimetatarsal head with an implant. Early results were found to be good for implants, although late results were poor and showed loosening, pain, malalignment, transfer metatarsalgia, and sesamoid pain.…”