Novel dynamic stabilization method for medial instability of the first metatarsophalangeal joint

Abstract

Medial collateral ligament injury of the first metatarsophalangeal (MTP) joint is rare. If it is missed, chronic instability and traumatic hallux valgus develop, requiring surgical treatment. Different methods have been reported in the limited available literature aiming to restore the balance between the lateral and medial stabilizers by tightening the medial joint capsule with or without additional tendon graft. Our described method utilizes a suture button device (Mini TightRope, Arthrex, Naples, Florida) for reconstruction. This device applies tension to hold the hallux in the correct position, providing stability. Relevant diagnostic regimen, surgical technique, and postoperative care are described, along with a case of a handball player who underwent this procedure. He continues to perform at the same level 38 months postoperatively. Mini TightRope fixation for chronic medial first MTP instability has not been reported. It does not require postoperative immobilization and allows faster return to sport, so it seems superior to other methods when treating athletes.

Reconstruction of the Lateral Collateral Ligament Using a Suture Tape Anchor for Iatrogenic Hallux Varus

“…In their procedure, 2.7 mm bone tunnels were created at the proximal phalanx and the metatarsal bone under fluoroscopy, whereafter suture tape was fixed using the 3.0 mm biotenodesis screws with congruent reduction. Other reports have shown the utility of a suture button device (mini Tigh-tRope R , Arthrex) for medial instability of the first MTP joint and traumatic hallux varus deformity [18][19][20]. Using these devices will enable less invasive joint stabilization surgery with a lower recurrence rate.…”