Operative Technique

BackgroundAlthough arthroscopic surgical treatment of the first metatarsophalangeal (MTP) joint involves painful sesamoid excision, synovectomy, debridement, and partial cheilectomy, no gold standard treatment technique has been defined in the literature for hallux rigidus and focal osteochondral lesions. This study aimed to assess the arthroscopic treatment for early-grade focal osteochondral lesions of the first MTP joint and to determine the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in a group of patients who failed conservative treatment.MethodsThis prospective study included 14 patients with hallux rigidus and focal osteochondral lesions of the first MTP joint who underwent surgery in 2014 and were followed on a regular basis thereafter.ResultsThe patients had mean preoperative VPS (visual pain scale) and AOFAS (American Orthopedic Foot and Ankle Society)-Hallux scores of 8.14 ± 0.86 SD and 48.64 ± 4.27, respectively; the corresponding postoperative values of both scores were 1.86 ± 0.66 SD and 87.00 ± 3.70, respectively. Both VPS and AOFAS-Hallux scores changed significantly.DiscussionIn this prospective study, we explored the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in patients with focal osteochondral lesions of the first MTP joint. Our results showed significant improvements in VPS and AOFAS scores with this treatment.ConclusionsAn arthroscopic microhole drill technique can be used with impressive functional scores and without any complications in patients who failed conservative therapy for hallux rigidus with focal chondral injury.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint

Kuyucu

Mutlu

et al. 2017

J Orthop Surg Res

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“…At this stage, conservative therapy consisting of nonsteroid anti-inflammatory drug (NSAID) use and footwear modification aims to suppress synovitis and joint inflammation and reduce pain [10–12]. However, surgical treatment may be preferred when conservative therapy fails in these young and active patients [11–14]. We first applied conservative treatment in the whole patient group, and we proceeded with surgery when that treatment failed.…”

Section: Discussionmentioning

confidence: 99%

“…We first applied conservative treatment in the whole patient group, and we proceeded with surgery when that treatment failed. Hallux valgus can be managed via open or arthroscopic surgery, depending on patient characteristics and disease stage [14, 15] Derner and Aldo showed that arthroscopic surgery was more beneficial than open surgery by being minimally invasive, having a shorter recovery period, requiring no special rehabilitation program, and allowing patients to return to daily activities quickly [16–18]. We achieved fast return to work with the arthroscopic approach in suitable patients since this approach caused no complications and allowed joint loading with as much weight as tolerated on the same day of surgery as mentioned in the literature [16, 17].…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint

Kuyucu

Mutlu

et al. 2017

J Orthop Surg Res

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BackgroundAlthough arthroscopic surgical treatment of the first metatarsophalangeal (MTP) joint involves painful sesamoid excision, synovectomy, debridement, and partial cheilectomy, no gold standard treatment technique has been defined in the literature for hallux rigidus and focal osteochondral lesions. This study aimed to assess the arthroscopic treatment for early grade focal osteochondral lesions of the first MTP joint and to determine the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in a group of patients who failed conservative treatment.MethodsThis prospective study included 14 patients with hallux rigidus and focal osteochondral lesions of the first MTP joint who underwent surgery in 2014 and were followed on a regular basis thereafter.ResultsThe patients had mean preoperative VPS (visual pain score) and AOFAS (American Orthopedic Foot and ankle Society)-Hallux scores of 8.14 ± 0.86 SD and 48.64 ± 4.27, respectively; the corresponding postoperative values of both scores were 1.86 ± 0.66 SD and 87.00 ± 3.70. Both VPS and AOFAS-Hallux scores changed significantly.DiscussionIn this prospective study, we explored the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in patients with focal osteochondral lesions of the first MTP joint. Our results showed significant improvements in VPS and AOFAS scores with this treatment.ConclusionsAn arthroscopic microhole drill technique can be used with impressive functional scores and without any complications in patients who failed conservative therapy for hallux rigidus with focal chondral injury.

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“… 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.…”

Section: Operative Managementmentioning

confidence: 99%

Republication of “Current Concepts Review: Hallux Rigidus”

Anderson

Baumhauer

2023

Foot & Ankle Orthopaedics

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Arthritis of the first metatarsophalangeal (MTP) joint, hallux rigid, is a common and disabling source of foot pain in the adult population. Hallux rigidus is characterized by diseased cartilage and large, periarticular osteophytes that result in a stiff, painful joint. Activity modification, sensible shoes, orthotics, anti-inflammatory medications and occasional intra-articular steroid injections can be attempted to alleviate the discomfort associated with hallux rigidus. A number of surgical options exist for the treatment of recalcitrant hallux rigidus. Cheilectomy is a useful treatment for dorsal impingement pain seen in mild hallux rigidus. A new polyvinyl alcohol hemi-arthroplasty implant has shown promising early and midterm results in the treatment of advanced hallux rigidus; however, arthrodesis of the first MTP joint remains the gold standard treatment for advanced hallux rigidus because of unpredictable outcomes after early-generation joint replacement implants.

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Operative Technique

Cited by 13 publications

References 20 publications

Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint

Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint

Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint

Republication of “Current Concepts Review: Hallux Rigidus”

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