scholarly journals Accessibility of the metatarsal head comparing distraction and plantarflexion in a 2‐portal technique for first metatarsophalangeal (MTP 1) joint arthroscopy

2021 ◽  
Vol 35 (S1) ◽  
Author(s):  
Lena Hirtler ◽  
Katharina Czerny ◽  
Reinhard Schuh ◽  
Madeleine Willegger
Keyword(s):  
Metatarsal Head ◽  
Portal Technique

scholarly journals Accessibility of the Metatarsal Head Comparing Distraction and Plantarflexion in a 2-Portal Technique for First Metatarsophalangeal (MTP 1) Joint Arthroscopy

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0049
Author(s):  
Madeleine Willegger ◽  
Katharina Czerny ◽  
Lena Hirtler
Keyword(s):  
Osteochondral Lesion ◽  
Metatarsal Head ◽  
Osteochondral Lesions ◽  
Surgical Equipment ◽  
First Metatarsal ◽  
Non Invasive ◽  
Fresh Frozen ◽  
The Mean ◽  
Portal Technique ◽  
Accessible Area

Category: Arthroscopy; Midfoot/Forefoot Introduction/Purpose: Arthroscopic treatment of osteochondral lesion of the first metatarsophalangeal (MTP1) joint is an established procedure. Non-invasive distraction is most commonly applied when a dorsal 2-portal technique is used. Alternatively, plantarflexion can be utilized. In order to compare the arthroscopic reachability of the first metatarsal head, a laboratory study in anatomical specimens was performed. Methods: Twenty matched pairs (n=40) of fresh-frozen lower leg specimens were obtained and randomly assigned into two groups, a distraction (DIS) and a plantarflexion (PF) group, respectively. A standard 2-portal approach (dorsolateral and dorsomedial portals) with a 1.9mm 30° scope was used. The arthroscopic accessibility of the first metatarsal head was evaluated using chondral picks. Markings at the metatarsal heads were made intraoperatively and measured after exarticulation. Results: In the DIS group the mean accessible area was 58.03%, while the accessible area in the PF group was 55.93%. Though there is a small difference between the two groups, this difference was not statistically significant (p=0.51). Range of motion of the MTP 1 joint did not affect reachability. In one specimen (2.5%) the dorsomedial hallucal nerve was injured during arthroscopy. Conclusion: Access to the MTP1-joint for the treatment of osteochondral lesions is similar using distraction or plantarflexion during arthroscopy. The plantarflexion technique has the advantage of less surgical equipment needed. The dorsomedial hallucal nerve is at danger at the medial portal.

scholarly journals Dual–Posteromedial Portal Technique for Complex Arthroscopy in the Posterior Knee

2021 ◽  
Vol 10 (2) ◽  
pp. e257-e261
Author(s):  
Zachary K. Christopher ◽  
Donald L. Dulle ◽  
Justin L. Makovicka ◽  
Anikar Chhabra
Keyword(s):  
Posterior Knee ◽  
Portal Technique

The Hallux Metatarsophalangeal Capsule: An Anatomic Study With Respect to Percutaneous Hallux Valgus Correction

2021 ◽  
pp. 107110072110272
Author(s):  
Kenneth M. Chin ◽  
Nicholas S. Richardson ◽  
John T. Campbell ◽  
Clifford L. Jeng ◽  
Matthew W. Christian ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hallux Valgus ◽  
Metatarsal Head ◽  
Cadaveric Study ◽  
Anatomic Study ◽  
Orthopedic Surgeons ◽  
Popular Knowledge ◽  
Fresh Frozen ◽  
The Mean ◽  
Anatomic Relationship

Background: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux metatarsophalangeal (MTP) proximal capsular origin on the metatarsal neck is essential for surgeons in planning and executing extracapsular corrective osteotomies. A cadaveric study was undertaken to further study this anatomic relationship. Methods: Ten nonpaired fresh-frozen frozen cadaveric specimens were used for this study. Careful dissection was performed, and the capsular origin of the hallux MTP joint was measured from the central portion of the metatarsal head in the medial, lateral, dorsal, plantarmedial, and plantarlateral dimensions. Results: The ten specimens had a mean age of 77 years, with 5 female and 5 male. The mean distances from the central hallux metatarsal head to the MTP capsular origin were 15.2 mm dorsally, 8.4 mm medially, 9.6 mm laterally, 19.3 mm plantarmedially, and 21.0 mm plantarlaterally. Conclusion: The MTP capsular origin at the hallux metatarsal varies at different anatomic positions. Knowledge of this capsular anatomy is critical for orthopedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus. Type of Study: Cadaveric Study.

Radiographic Measurements of the Affected and Unaffected Feet in Patients with Unilateral Hallux Limitus

2016 ◽  
Vol 106 (3) ◽  
pp. 172-181
Author(s):  
Andrew F. Knox ◽  
Alan R. Bryant
Keyword(s):  
Metatarsal Head ◽  
Radiographic Evaluation ◽  
Head Shape ◽  
Intrinsic Factors ◽  
Hallux Limitus ◽  
First Metatarsal ◽  
Radiographic Measurements ◽  
Angle Data ◽  
Significant Difference ◽  
First Ray

Background: Controversy exists regarding the structural and functional causes of hallux limitus, including metatarsus primus elevatus, a long first metatarsal, first-ray hypermobility, the shape of the first metatarsal head, and the presence of hallux interphalangeus. Some articles have reported on the radiographic evaluation of these measurements in feet affected by hallux limitus, but no study has directly compared the affected and unaffected feet in patients with unilateral hallux limitus. This case-control pilot study aimed to establish whether any such differences exist. Methods: Dorsoplantar and lateral weightbearing radiographs of both feet in 30 patients with unilateral hallux limitus were assessed for grade of disease, lateral intermetatarsal angle, metatarsal protrusion distance, plantar gapping at the first metatarsocuneiform joint, metatarsal head shape, and hallux abductus interphalangeus angle. Data analysis was performed using a statistical software program. Results: Mean radiographic measurements for affected and unaffected feet demonstrated that metatarsus primus elevatus, a short first metatarsal, first-ray hypermobility, a flat metatarsal head shape, and hallux interphalangeus were prevalent in both feet. There was no statistically significant difference between feet for any of the radiographic parameters measured (Mann-Whitney U tests, independent-samples t tests, and Pearson χ2 tests: P > .05). Conclusions: No significant differences exist in the presence of the structural risk factors examined between affected and unaffected feet in patients with unilateral hallux limitus. The influence of other intrinsic factors, including footedness and family history, should be investigated further.

Modified Austin Procedure for Correction of Hallux Valgus

1997 ◽  
Vol 18 (3) ◽  
pp. 119-127 ◽  
Author(s):  
Hans-Jörg Trnka ◽  
Alexander Zembsch ◽  
Hermann Wiesauer ◽  
Marc Hungerford ◽  
Martin Salzer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Hallux Valgus Angle ◽  
First Metatarsophalangeal Joint ◽  
Intermetatarsal Angle ◽  
Soft Tissue Procedure ◽  
Valgus Angle

The Austin osteotomy is a widely accepted method for correction of mild and moderate hallux valgus. In view of publications by Kitaoka et al. in 1991 and by Mann and colleagues, a more radical lateral soft tissue procedure was added to the originally described procedure. From September 1992 to January 1994, 85 patients underwent an Austin osteotomy combined with a lateral soft tissue procedure to correct their hallux valgus deformities. Seventy-nine patients (94 feet) were available for follow-up. The average patient age at the time of the operation was 47.1 years, and the average follow-up was 16.2 months. The average preoperative intermetatarsal angle was 13.9°, and the average hallux valgus angle was 29.7°. After surgery, the feet were corrected to an average intermetatarsal angle of 5.8° and an average hallux valgus angle of 11.9°. Sesamoid position was corrected from 2.1 before surgery to 0.5 after surgery. The results were also graded according to the Hallux Metatarsophalangeal Interphalangeal Score, and the functional and cosmetic outcomes were graded by the patient. Dissection of the plantar transverse ligament and release of the lateral capsule repositioned the tibial sesamoid and restored the biomechanics around the first metatarsophalangeal joint. There was no increased incidence of avascular necrosis of the first metatarsal head compared with the original technique.

scholarly journals A Novel Radiographic Measurement Method for the Evaluation of Metatarsophalangeal Joint Dislocation of the Lesser Toe in Patients with Rheumatoid Arthritis

2021 ◽  
Vol 18 (14) ◽  
pp. 7520
Author(s):  
Hideki Ohashi ◽  
Keiichiro Nishida ◽  
Yoshihisa Nasu ◽  
Kenta Saiga ◽  
Ryuichi Nakahara ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Roc Analysis ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Radiographic Measurement ◽  
Joint Dislocation ◽  
Severity Grading ◽  
Grade 3 ◽  
The Relationship ◽  
Mtp Joints

Dorsal dislocation of metatarsophalangeal (MTP) joints of the lesser toe frequently occurs in patients with rheumatoid arthritis (RA), and may cause painful and uncomfortable plantar callosities and ulceration. The current study examined the reliability and clinical relevance of a novel radiographic parameter (the MTP overlap distance [MOD]) in evaluating the severity of MTP joint dislocation. The subjects of the current study were 147 RA patients (276 feet; 1104 toes). MOD, defined as the overlap distance of the metatarsal head and the proximal end of the phalanx, was measured on plain radiographs. The relationship between the MOD and clinical complaints (forefoot pain and/or callosity formation) was analyzed to create a severity grading system. As a result, toes with callosities had a significantly larger MOD. ROC analysis revealed that the MOD had a high AUC for predicting an asymptomatic foot (−0.70) and callosities (0.89). MOD grades were defined as follows: grade 1, 0 ≤ MOD < 5 mm; grade 2, 5 ≤ MOD < 10 mm; and grade 3, MOD ≥ 10 mm. The intra- and inter-observer reliability of the MOD grade had high reproducibility. Furthermore, the MOD and MOD grade improved significantly after joint-preserving surgeries for lesser toe deformities. Our results suggest that MOD and MOD grade might be useful tools for the evaluation of deformities of the lesser toe and the effect of surgical intervention for MTP joints in patients with RA.

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