Basilar Thumb Arthritis: The Utility of Suture-Button Suspensionplasty

Background: We sought to compare the functional outcomes, radiographic outcomes, and complications of trapeziectomy and flexor carpi radialis (FCR) to abductor pollicis longus (APL) side-to-side tendon transfer with or without suture-button suspensionplasty for thumb basilar joint arthritis. Methods: Patients treated with and without suture-button suspensionplasty were compared over a 6-year period. Data were reviewed for complications and functional outcomes, including grip and pinch strength, range of motion, and visual analog scale (VAS) pain scores. Plain radiographs were independently reviewed at initial presentation and at final follow-up, including proximal phalanx length, trapezial space height, and trapezial height ratio. Results: Seventy thumb arthroplasties were performed in 70 patients. Trapeziectomy with FCR-APL side-to-side tendon transfer was performed in 39 patients, and trapeziectomy with FCR-APL side-to-side tendon transfer with suture-button suspensionplasty was performed in 31 patients. Mean length of follow-up was 28.4 ± 3.9 and 23.8 ± 2.6 months, respectively. Postoperative grip, oppositional and appositional pinch strength, and VAS pain scores improved compared with preoperative values, but were not significantly different based on suture-button suspensionplasty. Percentage decline in trapezial space ratio was significantly different between groups at 36.7% and 20.4% for procedures with and without suture-button suspensionplasty, respectively indicating that the trapezial space was better maintained within the suture suspension cohort. The incidence of postoperative complications, including surgical site infection, paresthesias, reoperation, complex regional pain syndrome, and symptomatic subsidence, was not significantly different between groups. Conclusions: Trapeziectomy with FCR to APL side-to-side tendon transfer with and without suture-button suspensionplasty results in comparable improvement in pain, grip strength, and functional parameters. Suture-button suspensionplasty results in significantly greater preservation of trapezial space.

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TL 18053 - Short-term results of lisfranc injuries treated with the suture button technique

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.1009 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. 67S

Author(s):

Guilherme Honda Saito ◽

Alberto Mendes ◽

Danilo Nishikawa ◽

Cesar Cesar Netto ◽

Beatriz Devito ◽

...

Keyword(s):

Functional Outcomes ◽

Insertion Site ◽

Short Term ◽

Radiographic Images ◽

Suture Button ◽

Radiographic Outcomes ◽

Loss Of Reduction ◽

The Mean ◽

Lisfranc Injuries

Introduction: Interosseous suture buttons can be used as an alternative technique for fixation of Lisfranc lesions. Theoretically, it may overcome the disadvantages of the rigid construct provided by plates and screws. The aim of the present study was to provide short-term results of Lisfranc injuries treated with the suture button technique. Methods: Sixteen consecutive patients with Lisfranc injuries requiring an operation were treated using the Mini Tight Rope® (Arthrex, Naples, FL). Medical records and radiographic images were analyzed with respect to functional outcomes, complications, need for reoperation and radiographic outcomes. The mean follow-up was 32 months. Functional outcomes were measured by the AOFAS midfoot score and the Visual Analogue Scale (VAS) at the latest follow-up. Results: At a mean follow-up of 32 months, the average AOFAS score was 95.8 and the mean VAS was 0.6. All patients but one were able to return to their previous activities. A total of 9 complications were observed in 6 patients, with discomfort at the button insertion site being the most common (4). Other complications included evidence of radiographic arthritis (3), loss of reduction (1) and extensor hallucis longus tendinopathy (1). Only 1 patient required a reoperation for removal of the suture button. Conclusion: Use of the suture button for fixation of Lisfranc injuries showed excellent results in the short-term. However, arthritis and/or loss of reduction were noted in 3 patients during follow-up, which could have been caused by the severity of the primary injury itself or by a lack of stability provided by the construct. Further studies are required to evaluate whether the suture button technique provides enough fixation to maintain reduction and prevent the development of arthritis in the long-term.

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Screw Versus Suture Button in Treatment of Syndesmosis Instability: Clinical and Radiographic Outcomes Using PROMIS and Weight Bearing CT Scan

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00080 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0008

Author(s):

Mohamed E. Abdelaziz ◽

Noortje Hagemeijer ◽

Daniel Guss ◽

Ahmed El-Hawary ◽

A. Holly Johnson ◽

...

Keyword(s):

Ct Scan ◽

Screw Fixation ◽

Weight Bearing ◽

Pilon Fracture ◽

P Values ◽

Normal Side ◽

Suture Button ◽

Radiographic Outcomes ◽

Injured Side

Category: Ankle, Sports, Trauma, Syndesmosis Introduction/Purpose: Traumatic injuries to the distal tibiofibular syndesmosis are relatively common and can be associated with ankle fractures or occur as purely ligamentous injuries. Unstable syndesmotic injuries require surgical repair, generally performed using either screw or suture button fixation. The superiority of either fixation method remains a subject of ongoing debate. The aim of this study is to compare both clinical and radiographic outcomes of screw and suture button fixation of syndesmosis instability using Patient-Reported Outcomes Measurement Information System (ROMIS) and weight bearing CT scan (WBCT). Methods: Medical records were reviewed to identify patients who had a unilateral syndesmotic injury requiring surgical stabilization and who were at least one year out from injury. Exclusion criteria included patients less than 18 years old, ipsilateral pilon fracture, history of contralateral ankle or pilon fracture or syndesmosis injury, BMI >40, and any neurological impairment. Twenty eligible patients were recruited to complete PROMIS questionnaires and undergo bilateral WBCT scan of both ankles, divided into two groups. In the first group (n=10) the patients had undergone screw fixation of the syndesmosis, while in the second group (n=10) the syndesmosis was fixed using a suture button construct. All patients completed PROMIS questionnaires for pain intensity, pain interference, physical function and depression. Radiographic assessment was performed using axial images of WBCT scan of both the injured ankle and the contralateral normal side at a level one cm proximal to the tibial plafond (Figure 1). Results: At an average follow up of three years, none of the recruited patients required a revision surgery. There was no significant difference between the two groups in terms of the four PROMIS questionnaires (P values ranged from 0.17 to 0.43). In the suture button group, the measurements of the injured side were significantly different from the normal side for the syndesmotic area (P=0.003), fibular rotation (P=0.004), anterior difference (P=0.025) and direct anterior difference (P=0.035). Other measurements of posterior difference, middle difference, direct posterior difference and fibular translation were not significantly different (P values ranged from 0.36 to 0.99). In the screw fixation group, the syndesmotic area was the only significantly different measurement in the injured side as compared to the normal side (P=0.006). Conclusion: Screw and suture button fixation for syndesmotic instability have similar clinical outcomes at average three years follow up as measured by PROMIS scores. Both screw and suture button did not entirely restore the syndesmotic area as compared to the contralateral normal ankle, suggesting some residual diastasis on weight bearing CT. In addition, as compared to screw fixation, the suture button did not seem to restore the normal fibular rotation, with residual external rotation of the fibula noted. Longer clinical follow up is necessary to understand the clinical implication of such malreduction.

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Syndesmotic Fixation Utilizing a Novel Metal Screw: A Retrospective Case Series Reporting Early Clinical and Radiographic Outcomes

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00410 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0041

Author(s):

Derek S. Stenquist ◽

Brian Velasco ◽

Patrick K. Cronin ◽

Jorge Briceno ◽

Christopher Miller ◽

...

Keyword(s):

External Rotation ◽

Case Series ◽

Break Point ◽

The Novel ◽

Suture Button ◽

Radiographic Outcomes ◽

Clear Space ◽

Anatomic Reduction ◽

Screw Breakage

Category: Ankle Introduction/Purpose: Syndesmotic disruption occurs in nearly 1 in 5 ankle fractures and requires anatomic reduction and internal stabilization to maximize functional outcomes. There is growing evidence to support retaining syndesmotic hardware from both a functional and economic standpoint. However, although broken screws are typically of little consequence, the location of screw breakage can be unpredictable and cause painful bony erosion and difficulty with extraction. The purpose of this investigation is to report early clinical and radiographic outcomes of patients who underwent syndesmotic fixation using a novel metal screw with a more predictable break point and design features to allow for easier extraction. Methods: We performed a retrospective review of all consecutive patients who underwent syndesmotic fixation utilizing the novel syndesmotic screw over a one year period. Demographic data were obtained such as age, gender, fracture classification and relevant comorbidities. Screw specific data were obtained such as number of screws utilized and length. Screw loosening or breakage was documented. Postoperative radiographs were reviewed and tibiofibular overlap, tibiofibular clear space and medial clear space were measured. Results: 18 patients met inclusion criteria. Mean length of clinical follow-up was 4.67 months (range 0.5 to 8.5 months). Per the Lauge Hansen classification, 14 injuries were supination external rotation type, two were pronation abduction and two pronation external rotation type. Three screws (12.5%) fractured at the break point with no screws fracturing at a different location. 21 screws did not fracture with 10 (42%) of the screws demonstrated to be loose. There was no evidence of syndesmotic diastasis or mortise malalignment on final follow up of the cohort. No screws required removal during the study period. There were no other complications of any type (Table 1). Conclusion: Early reporting of outcomes is essential to maximize both safety and value in healthcare technology innovation. This study provides the first clinical data on a novel alternative to traditional screws and suture button devices for fixation of syndesmotic injuries. At short-term follow up, there were no complications and the novel screw provided adequate fixation to allow healing and prevent diastasis. While initial results are favorable, longer term follow-up is required to determine whether this novel implant can reduce rates of symptomatic hardware requiring removal, which could ultimately make them more cost- effective than suture-button fixation.

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Screw Versus Suture Button in Treatment of Syndesmosis Instability: Clinical and Radiographic Outcomes Using PROMIS and Weight Bearing CT Scan

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00001 ◽

2020 ◽

Vol 5 (2) ◽

pp. 2473011420S0000

Author(s):

Mohamed Abdelaziz ◽

Daniel Guss ◽

Anne H. Johnson ◽

Christopher DiGiovanni ◽

Noortje Hagemeijer ◽

...

Keyword(s):

Ct Scan ◽

Screw Fixation ◽

Weight Bearing ◽

Pilon Fracture ◽

P Values ◽

Normal Side ◽

Suture Button ◽

Radiographic Outcomes ◽

Injured Side

Category: Trauma; Ankle; Sports Introduction/Purpose: Traumatic injuries to the distal tibiofibular syndesmosis are relatively common and can be associated with ankle fractures or occur as purely ligamentous injuries. Unstable syndesmotic injuries require surgical repair, generally performed using either screw or suture button fixation. The superiority of either fixation method remains a subject of ongoing debate. The aim of this study is to compare both clinical and radiographic outcomes of screw and suture button fixation of syndesmosis instability using Patient-Reported Outcomes Measurement Information System (PROMIS) and weight bearing CT scan (WBCT). Methods: Medical records were reviewed to identify patients who had a unilateral syndesmotic injury requiring surgical stabilization and who were at least one year out from injury. Exclusion criteria included patients less than 18 years old, ipsilateral pilon fracture, history of contralateral ankle or pilon fracture or syndesmosis injury, BMI >40, and any neurological impairment. Twenty eligible patients were recruited to complete PROMIS questionnaires and undergo bilateral WBCT scan of both ankles, divided into two groups. In the first group (n=10) the patients had undergone screw fixation of the syndesmosis, while in the second group (n=10) the syndesmosis was fixed using a suture button construct. All patients completed PROMIS questionnaires for pain intensity, pain interference, physical function and depression. Radiographic assessment was performed using axial images of WBCT scan of both the injured ankle and the contralateral normal side at a level one cm proximal to the tibial plafond ( Figure 1 ). Results: At an average follow up of three years, none of the recruited patients required a revision surgery. There was no significant difference between the two groups in terms of the four PROMIS questionnaires (P values ranged from 0.17 to 0.43). In the suture button group, the measurements of the injured side were significantly different from the normal side for the syndesmotic area (P=0.003), fibular rotation (P=0.004), anterior difference (P=0.025) and direct anterior difference (P=0.035). Other measurements of posterior difference, middle difference, direct posterior difference and fibular translation were not significantly different (P values ranged from 0.36 to 0.99). In the screw fixation group, the syndesmotic area was the only significantly different measurement in the injured side as compared to the normal side (P=0.006). Conclusion: Screw and suture button fixation for syndesmotic instability have similar clinical outcomes at average three years follow up as measured by PROMIS scores. Both screw and suture button did not entirely restore the syndesmotic area as compared to the contralateral normal ankle, suggesting some residual diastasis on weight bearing CT. In addition, as compared to screw fixation, the suture button did not seem to restore the normal fibular rotation, with residual external rotation of the fibula noted. Longer clinical follow up is necessary to understand the clinical implication of such malreduction.

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ARTHROSCOPIC EVALUATION AND TREATMENT BY TENDON INTERPOSITIONAL ARTHROPLASTY OF FIRST CARPOMETACARPAL JOINT ARTHRITIS

Hand Surgery ◽

10.1142/s0218810407003389 ◽

2007 ◽

Vol 12 (01) ◽

pp. 35-39 ◽

Cited By ~ 23

Author(s):

L. Pegoli ◽

C. Parolo ◽

T. Ogawa ◽

S. Toh ◽

G. Pajardi

Keyword(s):

Pinch Strength ◽

Carpometacarpal Joint ◽

Thumb Carpometacarpal Joint ◽

Mayo Score ◽

Basal Joint ◽

Palmaris Longus Tendon ◽

Thumb Carpometacarpal ◽

Tendon Interposition ◽

Joint Arthritis

Basal joint arthritis of the thumb is usually seen in females beginning from the fourth and fifth decades. In the last two decades, arthroscopic techniques have brought new chances of diagnosis and treatment for this condition. In this paper, the authors describe the indications and their experience concerning arthroscopic hemitrapezectomy and tendon interposition using the palmaris longus tendon. A series of 16 patients with a maximum follow-up of 12 months is analysed. All of the 16 patients were followed and assessed with grasp strength, pinch strength, DASH and MAYO evaluation score both pre- and post-operatively at 12 months follow-up. According to the MAYO score, there were six excellent results, six good, three fair and one poor. No complications occurred. According to our preliminary results, this procedure with the proper indications gives a valid option for the treatment of thumb carpometacarpal joint arthritis in stages I and II according to Eaton's classification.

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2020 IFFAS Award for Excellence Winner: Outcomes and Complications of Open versus Posterior Arthroscopic Subtalar Arthrodesis: A Prospective Randomized Controlled Multicenter Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00077 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0007

Author(s):

Chamnanni Rungprai ◽

Aekachai Jaroenarpornwatana ◽

Yantarat Sripanich ◽

Nusorn Chaiprom

Keyword(s):

Functional Outcomes ◽

Subtalar Joint ◽

T Test ◽

Return To Sports ◽

Subtalar Arthrodesis ◽

Sf 36 ◽

Significant Difference ◽

Subtalar Arthritis ◽

Joint Arthritis

Category: Hindfoot Introduction/Purpose: Open subtalar arthrodesis is a standard treatment for subtalar joint arthritis. Recently, posterior arthroscopic subtalar arthrodesis (PASTA) has been introduced and gained increasing popularity due to fasten recovery time and better cosmesis. However, there is limited current studies to report outcomes and complications between the two techniques. The purpose of this study is to compare outcomes and complications between open and PASTA techniques. Methods: A prospective, randomized collected data of 56 consecutive patients who were diagnosed with isolated subtalar arthritis and underwent either open (28 patients) or PASTA (28 patients) between 2016 and 2019 were enrolled in this study. The minimum follow-up time to be included in this study was 12 months. The primary outcome was union rate which was confirmed by post-operative CT scan. The secondary outcomes were union time, VAS, SF-36, FAAM, tourniquet times, and complications. A paired sample t-test was used to assess statistical differences between pre- and post-operative functional outcomes (VAS, SF-36, and FAAM) in the same group of both open and PASTA techniques while an independent t-test was used to compare functional outcomes (VAS, SF-36, and FAAM) between the two techniques. Results were significance at p < 0.05. Descriptive statistics were used for the demographic variables. Results: There were 56 patients (44 male and 12 female) with mean follow-up time was 17.7 months and 17.5 months for open and PASTA. The union time was significantly shorter in PASTA (9.4 vs 12.8 weeks, p<0.05). PASTA demonstrated significantly fasten recovery times (p<0.05 all) including time to return to ADL (8.4 vs 10.8 weeks), work (9.4 vs 12.8 weeks), and sports (9.4 vs 12.8 weeks). Both Open and PASTA techniques demonstrated significant improvement of all functional outcomes (FAAM, SF- 36, and VAS (p<0.01 all)); however, there was no significant difference between the two techniques. Other outcomes were not significant difference including tourniquet times (55.8 vs 67.2 minutes) and union rates (96.3 vs 100%) and complications. Conclusion: Both open and PASTA techniques demonstrated significant improvement of pain and function for treatment of patients with isolated subtalar joint arthritis. Although there was no significant difference of short-term of functional outcomes and complications, PASTA technique was better in term of shorten time to union and fasten time to return to sports.

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Functional and Radiographic Outcomes after the Removal of Suture-Button Fixation Device in the Treatment of Syndesmosis Diastasis

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00247 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0024

Author(s):

Jae Young Kim ◽

Jaeho Cho

Keyword(s):

Device Removal ◽

Fixation Device ◽

Aofas Score ◽

Spontaneous Reduction ◽

Suture Button ◽

Radiographic Outcomes ◽

Clear Space ◽

Before And After ◽

Postoperative Time

Category: Trauma Introduction/Purpose: Suture-button fixation device (TightRope, Arthrex, Naples, Florida) is devised to obviate the need for second operation for removal in the treatment of syndesmosis diastasis, but considerable removal rate has been reported. Nevertheless, functional and radiographic outcomes after suture-button fixation device removal has not yet been well documented. Therefore, the purpose of this study is to investigate the functional and radiographic outcomes of syndesmosis fixation treated with suture-button device before and after device removal. Methods: The records of 30 patients with syndesmosis injury who underwent suture-button fixation and later device removal between August 2009 and September 2017 were investigated. The mean postoperative time to device removal was 11.9 months (range, 7-19). In plain radiograph, tibiofibula clear space (TFCS), tibiofibula overlap (TFO), and medial clear space (MCS) were measured at three specific follow-up period; immediate postoperative (F1), just before device removal (F2), and at least three months after device removal (F3). For subgroup of 18 patients with CT scans, the Anterior to posterior (A/P) ratio (Normal range: 0.8 -1.2) was measured to investigate malreduction of syndesmosis and they were divided into two groups according to their accuracy of reduction. Additionally, functional outcomes were recorded and compared using American Orthopedic Foot and Ankle (AOFAS) score. Repeated measurement analysis of variance was performed to statistically compare the data and statistical significance was set at P < 0.05. Results: In plain radiographs, TFCS, TFO, MCS at three specific follow-up period showed no significant differences. In CT analysis at immediate postoperative period, 6 cases (30%) revealed malreduction, but 5 of them showed spontaneous reduction at follow- up just before device removal. Malreduced patients (n = 6) had a mean A/P ratio of 1.28 (range, 0.78 -1.52) at F1, 1.08 (range, 0.81- 1.21) at F2, and 1.08 (range, 0.83 -1.22) at F3 (F1, F2: p = 0.021, F1, F3: p = 0.032, F2, F3: p > 0.05). Patients with initial adequate reduction (n = 12) continued to have a reduced syndesmosis during the follow-up period and after the device removal. The AOFAS score did not change significantly before and after removal. Conclusion: Our investigation showed that the removal of suture-button device for syndesmosis fixation at average 1-year postoperative time does not bring out reduction loss or functional changes. Thus, removal is advisable for the patients with irritation or discomfort related to device. Furthermore, malreduced syndesmosis after tightrope fixation may have possibility of spontaneous reduction during the follow-up period.

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Modified total trapezial and partial trapezoidal excision and ligament reconstruction tendon interposition reduces symptoms in isolated scaphotrapezial-trapezoid arthritis of the wrist

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193411434718 ◽

2012 ◽

Vol 37 (7) ◽

pp. 637-641 ◽

Cited By ~ 10

Author(s):

J. Andrachuk ◽

S. S. Yang

Keyword(s):

Range Of Motion ◽

Grip Strength ◽

Ligament Reconstruction ◽

Pinch Strength ◽

Wrist Flexion ◽

Pain Scores ◽

Excision Arthroplasty ◽

Tendon Interposition

Trapezial excision arthroplasty with ligament reconstruction and tendon interposition (LRTI) modified to include proximal trapezoid excision was performed on 12 wrists in 10 patients with symptomatic, isolated scaphotrapezial-trapezoid (STT) arthritis. Wrist range of motion, lateral pinch and grip strength, and analog pain scores were measured pre- and post-operatively. Mean follow-up was 18 (11–42) months. Post-operatively, reported pain scores uniformly decreased ( p < 0.0001). Mean range of wrist flexion increased from 48 to 53° ( p < 0.05) and extension from 51 to 55° ( p < 0.05). There was also an overall increase in mean grip strength from 15.6 to 19.2 kg and pinch strength from 3.5 to 4.3 kg. Modified Mayo Wrist Scores were excellent in six cases, good in three, and fair in one. Our results suggest that modified total trapezial, partial trapezoidal excision and LRTI could be an effective surgical alternative in cases of isolated STT arthritis.

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Functional outcomes of post-traumatic metacarpal hand reconstruction with free toe-to-hand transfer

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.182232 ◽

2016 ◽

Vol 49 (01) ◽

pp. 16-25 ◽

Cited By ~ 5

Author(s):

Hari Venkatramani ◽

Praveen Bhardwaj ◽

Adam Sierakowski ◽

S. Raja Sabapathy

Keyword(s):

Functional Outcomes ◽

Pinch Strength ◽

Excellent Outcome ◽

Web Opening ◽

Hand Deformity ◽

Post Traumatic ◽

Objective Tests ◽

Toe Transfer ◽

Test Grip Strength

ABSTRACT Introduction: We present the functional outcomes of microvascular toe transfer to reconstruct the post-traumatic metacarpal hand deformity. Twelve toe transfers were successfully carried out in 11 patients. Materials and Methods: In each patient, the level of injury was classified according to the Wei classification system. Functional outcome was measured in seven patients using the Tamai score. Additional objective tests of function were carried out in three patients, including the Jebsen test, grip strength, pinch strength, web opening, static and moving two-point discrimination and Semmes–Weinstein monofilament testing. Observation and Results: The average Tamai score was 69 (range 60–83.5). Six patients achieved 'good' outcomes and one patient, with a double toe transfer, an 'excellent' outcome. The average follow-up time was 43 months (range 10–148 months). Conclusion: This study shows how even a single toe transfer can restore useful function to a hand that has otherwise lost all prehensile ability.

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Influence of First Metatarsophalangeal Joint Degenerative Changes on Functional Outcomes Following Hallux Valgus Correction

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00011 ◽

2020 ◽

Vol 5 (2) ◽

pp. 2473011420S0001

Author(s):

Ryan G. Rogero ◽

Andrew Fischer ◽

Daniel Corr ◽

Joseph T. O’Neil ◽

Daniel J. Fuchs ◽

...

Keyword(s):

Hallux Valgus ◽

Functional Outcomes ◽

Proximal Phalanx ◽

Metatarsal Head ◽

Degenerative Changes ◽

Foot And Ankle ◽

First Metatarsophalangeal Joint ◽

Pain Scores ◽

Plantar Aspect ◽

Exposed Bone

Category: Bunion; Other Introduction/Purpose: Previous studies have documented the prevalence of 1st metatarsophalangeal (MTP) joint arthritis in the setting of hallux valgus, with the articulation between the metatarsal head and the sesamoids being particularly vulnerable. However, little is known as to whether such degenerative changes of the metatarsal head-sesamoid articulation have any influence on postoperative functional and pain scores following hallux valgus correction. The purpose of this study is to determine the influence of degenerative changes of the 1st metatarsal head on outcomes at 2 years postoperatively. Methods: Patients who underwent correction of a hallux valgus deformity from 2016 to 2017 with 1 of 4 foot and ankle fellowship-trained orthopaedic surgeons were included in this study. Degenerative changes were classified using a novel grading system dividing the articular surface of the metatarsal head into 6 zones, with zones 1 through 4 representing the surface which articulates with the base of the proximal phalanx and zones 5 and 6 representing the plantar aspect of the metatarsal head. Cartilage loss in each zone was graded from 0-2, with a score of 0 representing the absence of arthritis, a score of 1 indicating fissures without exposed bone, and a score of 2 representing degenerative changes with exposed bone, for a maximum score of 12. Scoring was performed by the operating surgeon at the time of the index procedure by direct visualization. Photographic documentation of the metatarsal head was obtained in every case for secondary confirmation. At 2 years postoperatively, patients with intraoperative grading were contacted to complete the Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscales and Visual Analog Scale (VAS) for pain. Spearman’s correlations and one-way ANOVA were performed to determine if the degree of arthritis had any influence on outcomes. Results: Seventy-six patients (92.1% female) with both intraoperative arthritic grading and 2-year functional outcomes were included. At a mean of 24.6 (range, 23-28) months postoperatively, patients reported a mean (+- standard deviation) FAAM-ADL of 93.0 +- 11.9/100, FAAM-Sport of 84.8 +- 21.4/100, and VAS pain of 16.8 +- 22.2/100. Arthritis in zone 1 (r=0.345, p= 0.005) and zone 4 (r=0.249, p=0.044) was found to be positively correlated with FAAM-Sport scores. ANOVA analysis revealed those with a total arthritis grade of 0 or 2 or more in zones 1-4 had a significantly greater reduction in VAS pain scores (means of -36.5 and -48.1, respectively) than those with a grade of 1 (mean: +5.0) (p=0.005). Conclusion: We have demonstrated a significant influence of arthritis on 2-year functional outcomes following HV correction, with higher levels of degenerative changes in zones 1 and 4 generally associated with better functional outcomes. While this finding was unexpected, it demonstrates that those with arthritis may benefit more from surgical correction of HV. Furthermore, surgeon intraoperative evaluation of arthritis may allow for improved counseling of patients regarding expected postoperative functional improvement.

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