Interpositional Arthroplasty of the Great Toe Metatarsophalangeal Joint Using Autogenous Fascia Lata for Advanced Hallux Rigidus

Outcomes Following Interposition Arthroplasty of the First Metatarsophalangeal Joint for the Treatment of Hallux Rigidus: A Systematic Review

“…The most common complication reported was transfer metatarsalgia of 1 or more lesser toes, with the range of incidence from 0.0% to 57.9%. Less frequent complications reported included calluses under the lesser metatarsal heads (27.3%-42.8%), 15,34 stress fracture of one of the lesser toes resulting from transfer metatarsalgia (4.8%-9.1%), 10,21,23,31,34 sensory neuroma or hyperpigmentation at the site of autograft harvesting (6.7%-14.3%), 15,21 radiographic evidence of osteonecrosis of the first metatarsal head (7.7%-40.8%), 10,51 numbness at the dorsum of the hallux or generalized hypoesthesia of the hallux (9.1%-15.8%), 10,45,51 infection with or without need for subsequent debridement (1.5%-6.7%), 2,20,21 cock-up deformity (4.5%), 2 proximal phalangeal cystic development (8.7%), 16 claw-toe deformity (5.6%), 20 extensor hallucis longus (EHL) tendon entrapment (3.1%), 27 capsular ossification (4.5%), 51 and regional pain syndrome (4.5%). 51…”

“…49 Many of these studies have surfaced in the literature in recent years, as the movement toward both promoting chondrostimulation and regeneration and developing matrices to serve as functional chondral replacement has gained momentum. [18][19][20][21]27,29,55 Interestingly, studies reporting on opportunities for biopsy of autogenous interposed capsular tissue in the setting of surgery needed on the lesser rays after interposition arthroplasty have noted the appearance of a viable fibrocartilaginous flap in the first MTP joint. 2,43 Despite all of these innovative and promising efforts, only 1 of the studies included in this review evaluated autogenous and allogeneic interpositional material comparatively, noting no difference in failure rate or incidence of transfer metatarsalgia between the placement of autogenous dorsal capsule and acellular dermal matrix allograft.…”

“…2 Immunogenic reactions have been reported anecdotally with allografting of the first MTP joint, whereas autogenous "bundle soft tissue" placement has been associated with donor site morbidity. 15,21 Although the isolated dorsal and medial autogenous capsular interpositional techniques can minimize these potential complications, the local capsular interpositional techniques may not provide sufficient tissue for grafting, particularly of the sesamoid-metatarsal articulation. Additionally, although the technique has evolved over time to minimize the extent of phalangeal resection and to preserve plantar proximal phalangeal attachments, transfer metatarsalgia is still observed with some frequency as a postoperative complication.…”

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

“…15 Multiple graft options have been described, including autogenous fascia lata, gracilis autograft, tendon allograft, amniotic membrane graft, collagenous tissue matrix, and meniscal allograft, all with favorable outcomes. 7,8,10,11,13,15 Interpretation of this is limited, however, due to the nonuniformity of outcome measures. To date there are no highquality level I studies describing outcomes of interposition arthroplasty.…”

Current Concepts Review

“…7 Six patients were identified in a follow-up study at an average of 5.4 years following surgery and all 6 patients remained satisfied. 39 Additionally, meniscal allograft, 21 amniotic fluid membrane, 24 and fascia lata 29 have been advocated. Other authors have advocated for local tissue transfer for interposition.…”