Comparison of Osteochondral Autologous Transplantation and Dorsiflexion Closing Wedge Metatarsal Osteotomy for Late-Stage Freiberg Disease in Adults

Abstract

Background: This study aimed to compare the clinical results between osteochondral autologous transplantation (OAT) and dorsiflexion closing wedge metatarsal osteotomy (DCWMO) in symptomatic adult patients with late-stage Freiberg disease. Methods: Between 2012 and 2017, patients with late-stage Freiberg disease surgically treated with OAT (12 patients) or DCWMO (15 patients) were retrospectively identified. The American Orthopaedic Foot & Ankle Society–lesser metatarsophalangeal-interphalangeal (AOFAS-LMI) score, visual analog scale score for subjective pain, and range of motion (ROM) were determined preoperatively and at final follow-up. Postoperative complications were also recorded. Results: The AOFAS-LMI score at final follow-up was significantly greater in the OAT group than in the DCWMO group (95.7 vs 87.9, P < .001), whereas plantarflexion at final follow-up was significantly lower in the DCWMO group than in the OAT group (30.0 vs 24.0 degrees, P = .037). The DCWMO group reported more postoperative complications including postoperative joint stiffness, deformity, and pain recurrence. In the OAT group, one patient complained of mild knee pain. Conclusion: OAT seemed a better procedure for late-stage Freiberg disease compared with DCWMO in adult patients in terms of postoperative functional score and ROM, with lower complication rates. Level of Evidence: Level III, retrospective comparative study.

Dorsal Metatarsal Closed Wedge Osteotomy in the Treatment of Freiberg’s Disease: A Prospective Observational Study

“…Although more than 100 years have passed since the definition of the disease and many surgical treatment methods have been described, there is no consensus on which method is the gold standard among the surgical treatment options. DMCWO has been widely used in practice, with many authors reporting successful results [8,15,16,17,18,19]. Some authors have modified the DMCWO by applying it to the extra-articular metaphyseal region [8,9].…”

“…Another technique that has been used in the treatment of Freiberg's disease and that has come to the fore recently is osteochondral tissue transplantation (OTT) [18,28,29]. Georgiannos et al compared OTT and DMCWO in a prospective randomized controlled study published in 2019.…”

Evidence-Based Treatment Algorithm for Freiberg Disease

“…Kim et al . 37 compared OAT and DFO among adult patients with late-stage Freiberg disease. The mean AOFAS score was significantly better in the OAT group, and the plantar flexion angle was significantly lower the DFO group.…”