Functional Outcomes of Local Pedicle Graft Interpositional Arthroplasty in Adults With Severe Freiberg’s Disease

Abdul, Wahid; Hickey, Ben; Perera, Anthony

doi:10.1177/1071100718786494

Cited by 10 publications

(6 citation statements)

References 26 publications

(40 reference statements)

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“…6 A case report also suggested using palmaris longus autograft as an interpositional allograft with a satisfactory outcome. 12 Recently, Abdul et al 1 described the use of a local pedicle graft as an interposition, called a “Rollmop,” for severe Freiberg disease. They studied 25 patients and found a significant decrease in VAS pain scores and an increase in American Orthopaedic Foot & Ankle Society ankle-hindfoot scale scores.…”

Section: Discussionmentioning

confidence: 99%

“…Other authors have described, in small series or case reports, procedures using a variety of soft tissues and synthetic materials for interpositional arthroplasties including dorsal capsule, 9 extensor digitorum brevis, 14 extensor digitorum longus, 6 palmaris longus autograft, 12 and silicone. 2 Recently, Abdul et al 1 described the use of a local pedicle graft as an interposition arthroplasty for severe Freiberg disease. Coughlin and Shurnas 4 described the use of a rolled allograft tendon as an interposition soft tissue arthroplasty for the treatment of advanced hallux rigidus with preparation of both sides of the first MTP joint to accept the spherical graft.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of Lesser Metatarsophalangeal Joint Interpositional Arthroplasty With Tendon Allograft

et al. 2020

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Background: Lesser toe metatarsal head degeneration and collapse can cause significant pain and disability. In the setting of global metatarsal head collapse, there are limited operative options. The purpose of our study was to evaluate clinical and radiographic outcomes after lesser toe metatarsophalangeal (MTP) joint interpositional arthroplasty with a tendon allograft and to describe the operative technique. Methods: We retrospectively reviewed a consecutive series of patients treated by 3 fellowship-trained foot and ankle surgeons at one institution. We created a phone survey to evaluate satisfaction, pain, and likelihood to repeat the surgery. Foot and Ankle Ability Measure (FAAM) scores were reviewed before and after surgery. Preoperative and postoperative radiographs were evaluated for preservation of metatarsal length. The procedure was performed through a dorsal midline approach. The metatarsal head was reamed to a concave shape. A tendon allograft was fashioned into a ball and secured to the metatarsal with an anchor. Fifteen feet in 14 patients underwent lesser MTP joint interposition arthroplasty, with the average age of 49 years (range, 24-69), and an average follow-up of 4.2 years. Results: Eighty percent (12/15) reported they would have the procedure again. Visual analog scale pain scores showed a decrease in pain from 7 to 1. FAAM sports subscale improved from 56% to 85%. Radiographically, the ratio of the affected metatarsal length to the adjacent metatarsal remained constant before and after surgery, suggesting preservation of the metatarsal cascade. Conclusion: Interpositional arthroplasty of the lesser MTP joints with a rolled tendon allograft provided a unique solution, as it allows the surgeon to fill a large void without harvesting an autograft. This study showed improved patient-reported outcomes, high patient satisfaction, and good radiographic outcomes. Lesser metatarsophalangeal joint allograft interposition arthroplasty was a viable solution as a salvage procedure in the setting of global metatarsal head collapse. Level of Evidence: Level IV, retrospective case series.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Outcome of Lesser Metatarsophalangeal Joint Interpositional Arthroplasty With Tendon Allograft

et al. 2020

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“…3 Several articles have reported good clinical outcomes of interposition arthroplasty using soft tissue such as the extensor digitorum longus, extensor digitorum brevis, palmaris longus, periosteum with a fat pedicle graft, and allograft of the semitendinosus tendon. [39][40][41][42][43][44] Çevik et al 44 reported the mid-to long-term results of interposition arthroplasty with the extensor digitorum brevis tendon. After a mean follow-up 133.8 (range, 60-198) months, the AOFAS scores improved as did the range of motion in dorsiflexion and plantar flexion.…”

Section: Joint-sacrificing Procedures Interposition Arthroplastiesmentioning

confidence: 99%

Section: Joint-sacrificing Proceduresmentioning

confidence: 99%

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Evidence-Based Treatment Algorithm for Freiberg Disease

Yoshimura,

Takao,

Wagner

et al. 2023

CARTILAGE

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Freiberg disease is a type of osteonecrosis of the metatarsal head that predominantly occurs in young females and adolescents, although it may occur at any age. The pathophysiology is multifactorial and may involve trauma, altered foot biomechanics, systemic disorders, and arterial insufficiency. The most typical location is the second metatarsal head, but Freiberg disease may also occur in other lesser toes. Nonoperative treatment is best applied in the early stage of the disease; if this is ineffective, surgical treatment is recommended. Currently available surgical procedures include debridement, osteotomy, osteochondral grafting, microfracture, interposition arthroplasty, implant arthroplasty, and metatarsal shortening arthroplasty. In this article, we propose a treatment algorithm for Freiberg disease based on the current literature and expert opinion.

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