Interpositional Arthroplasty With Extensor Digitorum Brevis Tendon in Freiberg Disease

Abstract

Background: No consensus has been reached in the treatment of Frieberg disease. Our aim was to evaluate medium- to long-term results of patients with advanced Freiberg disease managed with extensor digitorum brevis tendon interpositional arthroplasty. Methods: There were 24 patients (19 females, 5 males) managed with interpositional arthroplasty for advanced Freiberg disease between 2003 and 2015. The mean follow-up was 133.8 (range, 60-198) months. According to Smillie classification, there were 4 grade 3, 13 grade 4, and 7 grade 5 patients. Patients were evaluated preoperatively and at the final follow-up with the American Orthopaedic Foot & Ankle Society (AOFAS) score and metatarsophalangeal joint range of motion and postoperatively with visual analog scale (VAS) and subjective satisfaction evaluation. Joint space was evaluated on x-rays. Results: Mean AOFAS score increased (53.9 to 80.3, P = .001). Eight patients had excellent, 14 had good, and 2 had fair scores. A significant increase was found in dorsiflexion (38.1° [24°-52°] vs 55.3° [34°-65°]; P = .001) and plantarflexion (19.0° [10°-28°] vs 28.6° [19°-39°]; P = .001). Narrowing of the joint space was not seen in any patient, but expansion was determined in all patients (0.39 [0.35-0.47] vs 0.44 [0.41-0.47] cm; P = .002). Of the patients, 9 were very satisfied, 12 were satisfied, 2 were moderately satisfied, and 1 was dissatisfied. The mean postoperative VAS pain score was 1.7 ± 0.9 (0-4). Conclusion: After a minimum 5-year follow-up, most patients with Freiberg disease managed with interpositional arthroplasty using the extensor digitorum brevis tendon had excellent to good functional results with a widening of the joint space. Level of Evidence: Level IV, retrospective case series.

Evidence-Based Treatment Algorithm for Freiberg Disease

“…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.…”

“… 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 - 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.…”