scholarly journals Joint Preservation of the 1st MTP

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Bryan Van Dyke ◽  
Gregory Berlet ◽  
Justin Daigre ◽  
Christopher Hyer ◽  
Terrence Philbin
Keyword(s):  
Articular Cartilage ◽  
Early Detection ◽  
Metatarsal Head ◽  
Hallux Rigidus ◽  
Pain Level ◽  
Foot And Ankle ◽  
Inclusion Criteria ◽  
First Metatarsal ◽  
The Mean ◽  
One Year

Category: Midfoot/Forefoot Introduction/Purpose: Focal damage to articular cartilage and the supporting subchondral plate, commonly referred to as an osteochondral defect (OCD), can be a cause of joint pain and subsequent decreased range of motion. There are few studies specifically describing these lesions in the first metatarsophalangeal (MTP) joint, where they are traditionally grouped into hallux rigidus. There exists an opportunity for early detection and intervention with the intent to prevent deterioration and improve patient outcomes. One contemporary treatment concept is to implant particulated juvenile cartilage allograft to restore articular cartilage. The aim of our study was to review the clinical results of patients that had undergone this procedure for first metatarsal head OCDs. Methods: After IRB approval, a retrospective review of a consecutive case series was studied utilizing the records of three foot and ankle surgeons. Inclusion criteria included all adult patients who were a minimum of one year post surgery and consented to participate. Patient demographics and preoperative visual analog scale (VAS) pain level were recorded from a standardized intake sheet. From the operative note, the OCD size and location was recorded, as well as any concomitant procedures. At a minimum follow up of one year, we obtained objective measurements of arthritis grade and subjective considerations of pain and function, including VAS pain level, Foot Function Index (FFI) questionnaire, the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal scale, and an overall patient satisfaction score. Results: Nine patients met inclusion criteria, 4 males and 5 females. The average age was 41 years old (±11.77, range 21-65). The mean preoperative VAS pain score was 57.50 (±18.32, range 30-80). Four OCDs were located centrally on the first metatarsal head. The average OCD size intraoperatively was 30 mm2 (range 16-49). The average time since surgery was 3.26 years (±1.21, range 1.41-5.62). Average first MTP dorsiflexion was 41.78 degrees (±20.70, range 6-70). The average postoperative hallux rigidus classification was grade 2 (range 1-3). The mean VAS pain score improved to 5.22 (±8.44, range 0-20). The average AOFAS score was 88 (±15.91, range 52-100). The average FFI score was 8.04 (±12.60, range 0-30.6). All but one patient were satisfied or very satisfied with their results. Conclusion: At an average of 3.26 years postoperatively, patients had improved pain, did not show significant progression of their first MTP joint degeneration, and were satisfied with their results. Patients reported very little, if any, limitations in their activity level. We believe that articular damage of the first MTP should be viewed in the same way as OCD lesions in larger joints with emphasis on early detection and treatment to avoid the progression to arthritis. Particulated juvenile cartilage allograft is a valuable tool for surgeons to use in treating focal articular defects of the first metatarsal head.

scholarly journals Pain course after foot and ankle surgery

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Christian Plaass ◽  
Sarah Ettinger ◽  
Leif Claassen ◽  
Christina Stukenborg-Colsman ◽  
Kiriakos Daniilidis ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Characteristic Curve ◽  
Tertiary Care ◽  
Pain Level ◽  
Foot And Ankle ◽  
Primary Surgery ◽  
Ankle Surgery ◽  
The Mean ◽  
One Year ◽  
A Prospective Study

Category: Pain managment Introduction/Purpose: Most surgeons believe, that the postoperative pain course after foot and ankle surgery differs from other joints due to the initial protection and immobilization. The knowledge of the normal pain course after foot and ankle surgery is important to know for the surgeon and correctly inform patients preoperative and may help to identify abnormal postoperative healing courses. Methods: 180 patients were enclosed in a prospective study. 66,7% were female and 33.3% were male. All patients had primary surgery for foot and ankle diseases at a tertiary care foot and ankle center. The pain course was measured using a VAS over a one year period. The mean age was 53,2 (±13.6) years. Results: The mean pain level was 4.56 (± 2.0) preoperative. In the first postoperative week it was 3.5 (± 2.18) and declined until the 6th postoperative week to 1.57 (± 1.52) it increased again after the sixth week up to 1.95 (± 1.63) and decreased then again to 1.09 (± 1.51) one year postoperative. The pain level in patient with tendon surgeries tended to be higher in the first 12 weeks postoperative than that of patients with bony procedures. Conclusion: The pain course after Foot and ankle surgery shows a characteristic curve with a significant increase of the pain level after 6 weeks. A comprehensive patient information can increase satisfaction rates of the patient. Any abnormal postoperative pain course should arise suspection of a complicated healing period.

scholarly journals Meniscus Repair Outcomes with and without Bone Marrow Aspiration Concentrate

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0028 ◽  
Author(s):  
Patrick Allan Massey ◽  
Andrew Zhang ◽  
Christine Bayt Stairs ◽  
Stephen Hoge ◽  
Trevor Carroll ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspiration ◽  
Meniscus Repair ◽  
Control Group ◽  
Pain Level ◽  
Average Pain ◽  
The Mean ◽  
One Year ◽  
The One

Objectives: The purpose of the current study is to review the results of meniscus repairs with and without bone marrow aspiration concentrate (BMAC). It is hypothesized that with BMAC, meniscus repair outcomes will be improved when compared to without BMAC at 1 year after surgery. Methods: This is a prospective case control study performed from August 2014 until August 2017. Patients were included if they had a meniscus repair performed with no history of prior meniscus surgery to the operative knee. Patients were excluded if there was a full thickness cartilage tear or International Cartilage Repair Society (ICRS) Grade IV cartilage tear not treated in a single staged surgery. Patients were also excluded if they did not reach the one year follow-up, had a multi-ligamentous knee injury requiring multiple staged procedures. From August 2014 until November 2015, patients had meniscus repair without BMA. Menisci were all repaired arthroscopically using inside-out, outside-in and all-inside techniques. After November 2015, all meniscus repairs were augmented with BMAC. In the BMAC group, all bone marrow was obtained from the ipsilateral femur during the time of surgery. The Biocue BMAC system (Zimmer Biomet, Warsaw Indiana) was used for bone marrow aspiration and BMAC was injected directly into the tear site after repair. Numerical data such as VAS, lysholm and IKDC was analyzed using a 2 sample T-test. Categorical data such as sex, tear location, type of tear and zone of tear were analyzed using a chi-square. Results: A total of 150 patients were initially included in the study. The average age in the control group was 26.3 versus 29.4 in the BMAC group (P=0.27). Thirty seven percent of the control group had an ACL reconstruction versus 40% in the BMAC group (P= .77). The control group improved from an average pain level of 6.1 to 1.2 and the BMAC group improved from an average pain level of 5.9 to 0.7 at the 1 year end point. Both the control group and BMAC group improved with respect to pain with no difference at the 1 year end point (P=.19). There was, however a significantly larger reduction in pain at the 6 week and 3 month time point with BMAC compared to the control group (P=.02 and P=.02 respectively). At the 1-year follow-up, the mean lysholm score improved from 43 to 92 in the control group and 43 to 90 in the BMAC group. The mean IKDC score improved from 37 to 87 in the control group and 36 to 83 in the BMAC group at the one year follow-up. Conclusion: Meniscus repair outcomes were improved at 6 weeks and 3 months post-operatively, when BMAC is used to augment meniscus repair compared to repair without BMAC. Both groups, control group and BMAC meniscus repair group had improved outcomes at 1 year post-operatively with respect to VAS, lysholm and IKDC, with no difference in complication rate.

Forefoot Adductus Correction in Clubfoot Deformity with Cuboid-Cuneiform Osteotomy

2007 ◽  
Vol 97 (2) ◽  
pp. 126-133 ◽  
Author(s):  
Daniel K. Lee ◽  
Marc Benard ◽  
Nicholas Grumbine ◽  
Mitchell Pokrassa ◽  
Stan Weinstein
Keyword(s):  
Treatment Delay ◽  
Idiopathic Clubfoot ◽  
Inclusion Criteria ◽  
Residual Deformity ◽  
First Metatarsal ◽  
Average Patient ◽  
The Mean ◽  
Clinically Significant ◽  
Medial Release

Background: Forefoot adduction is the most common residual deformity in the treatment of pediatric clubfoot. Little documentation exists regarding its late occurrence and early detection. A retrospective analysis was conducted to determine the effect of primary posterior medial release for idiopathic clubfoot that had failed to improve with conservative treatment or had presented after a treatment delay and a subsequent forefoot adduction correction with a cuboid-cuneiform osteotomy. Methods: Radiographic evaluations were conducted of all of the surgical procedures performed at our institution for idiopathic clubfoot during a specified period. Preoperative and postoperative talo–first metatarsal and talocalcaneal angles were measured radiographically. Of 138 patients with clubfoot deformity who met the inclusion criteria, 51 underwent a primary posterior medial release; of these patients, 18 (26 feet) underwent a subsequent cuboid-cuneiform osteotomy. Results: The average preoperative and postoperative talo–first metatarsal anteroposterior angles for patients who underwent primary posterior medial release were 44.6° and 26.8°, respectively. The mean reduction in forefoot adduction was 17.8° (P < .05). After the osteotomy, the average talo–first metatarsal anteroposterior angle was 16°, with an average reduction of 10.8° (P < .05). Mean follow-up was 61.2 months. The average patient age was 3.2 years. Conclusions: Eighteen (35%) of 51 patients who underwent a posterior medial release required a subsequent cuboid-cuneiform osteotomy. The average reduction of 10.8° was statistically significant and has also proved to be clinically significant in the overall correction of the deformity. (J Am Podiatr Med Assoc 97(2): 126–133, 2007)

Evaluation of first metatarsal head declination through a modified distal osteotomy in hallux rigidus surgery. A cadaveric model

2015 ◽  
Vol 21 (3) ◽  
pp. 187-192 ◽  
Author(s):  
Jordi Asunción ◽  
Daniel Poggio ◽  
Manuel J. Pellegrini ◽  
Rodrigo Melo ◽  
José Ríos
Keyword(s):  
Metatarsal Head ◽  
Hallux Rigidus ◽  
First Metatarsal ◽  
Distal Osteotomy ◽  
Cadaveric Model

Metatarsophalangeal and Intermetatarsal Angle: Different Values and Interpretation of Postoperative Results Dependent on the Technique of Measurement

1998 ◽  
Vol 19 (8) ◽  
pp. 532-536 ◽  
Author(s):  
Wolfgang Schneider ◽  
Karl Knahr
Keyword(s):  
Articular Surface ◽  
Metatarsal Head ◽  
Postoperative Evaluation ◽  
Postoperative Results ◽  
Intermetatarsal Angle ◽  
Mean Values ◽  
First Metatarsal ◽  
The Mean ◽  
Postoperative Improvement ◽  
Type Of Surgery

For measurement of the first metatarsophalangeal angle and intermetatarsal angle I-II, five different methods for drawing the axis of the first metatarsal have been published. This study aimed to evaluate differences in the resulting angles that depend on the method of drawing this axis. Using pre- and postoperative radiographs of 20 patients who had surgery on the hallux (chevron procedure), highly significant differences were found: mean values for the preoperative metatarsophalangeal angle ranged from 27.3° to 31.9° the mean postoperative values were calculated at 8.6° to 20.3°. The preoperative mean of intermetatarsal angle I-II showed values from 13.0° to 17.6° the postoperative mean ranged from 5.2° to 16.7°. These differences-especially in the postoperative evaluation-resulted in a postoperative improvement between 11.6° and 20.8° for the metatarsophalangeal angle and between 0.9° and 10.0° for the intermetatarsal angle. These wide differences seem to be unacceptable for angles as a criterion of success in surgery on the hallux. The reason for these discrepancies can be found in the different relations of the points of reference to the anatomical outline of the metatarsal and the site of osteotomy. As a consequence of this study, defining the axis of the first metatarsal as a line connecting the center of the articular surface of the metatarsal head and the center of the proximal articulation can be recommended as the most appropriate method. The resulting angles are independent of the type of surgery performed on the hallux.

scholarly journals The Shape of the First Metatarsal Head and its Association with its Pronation Angle and the Presence of Sesamoid-Metatarsal Joint Osteoarthritis

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0037
Author(s):  
Yoshimasa Ono ◽  
Satoshi Yamaguchi ◽  
Seiji Kimura
Keyword(s):  
Hallux Valgus ◽  
Weight Bearing ◽  
Qualitative Evaluation ◽  
Metatarsal Head ◽  
First Metatarsal ◽  
Lateral Edge ◽  
Ankle Surgery ◽  
History Of ◽  
Joint Deformation ◽  
The Mean

Category: Bunion Introduction/Purpose: The rounded shape of the first metatarsal head’s lateral edge on the dorsoplantar radiograph of the foot is used as a qualitative evaluation of the first metatarsal pronation in hallux valgus feet. However, the relationship between the rounded shape and the metatarsal pronation angle of the first metatarsal has not been examined in detail. Furthermore, hallux valgus often accompanies osteoarthritis in the sesamoid-metatarsal joint. Deformation of the metatarsal head by osteophytes on the lateral edge of the lateral sesamoid facet may affect the rounded shape. The purpose of this study was to evaluate the associations of the shape of the first metatarsal head with (1) the presence of osteoarthritis in the sesamoid-metatarsal joint and (2) the pronation angle of the first metatarsal head. Methods: Patients were prospectively recruited between December 2016 and March 2017. Patients with a history of previous foot and ankle surgery or destruction of the head due to rheumatoid arthritis were excluded. A total of 121 patients, with the mean age of 61 years, underwent weight-bearing dorsoplantar, lateral, and first metatarsal axial radiographs. The shape of the first metatarsal head’s lateral edge was classified as either rounded, intermediate, or angular in shape in the dorsoplantar view. The presence of osteoarthritis in the sesamoid-metatarsal joint and the pronation angle of the first metatarsal head were assessed in the first metatarsal axial view. Other variables that could affect the first metatarsal shape, including the lateral first metatarsal inclination angle, were also assessed. Univariate and multivariate analyses were performed to determine the associations of the rounded shape of the first metatarsal with the pronation angle and sesamoid-metatarsal joint osteoarthritis. Results: Of 121 feet, 31, 41, and 49 feet had rounded, intermediate, and angular metatarsal heads, respectively. Sesamoid- metatarsal joint osteoarthritis was evident in 49 (40%) feet. The mean hallux valgus and first metatarsal pronation angle was 23° and 9°, respectively. The prevalence of sesamoid-metatarsal osteoarthritis was significantly higher (24 (77%), 11 (27%), and 14 (29%) for rounded, intermediate, and angular, respectively, P < .001) in feet with a rounded metatarsal head. Furthermore, the metatarsal pronation angle was significantly larger (14°, 8°, and 4° for rounded, intermediate, and angular, respectively, P < .001). These associations were also significant in the multiple regression analysis. Conclusion: A rounded metatarsal head was associated with a higher prevalence of osteoarthritis within the sesamoid-metatarsal joint, as well as a larger first metatarsal head pronation angle. A negative round sign can be used as a simple indicator of an effective correction to the first metatarsal pronation angle during hallux valgus surgery. However, in feet with sesamoid-metatarsal osteoarthritis, surgeons will need to be cautious as overcorrection may occur.

scholarly journals Outcomes following Subchondroplasty in the First Metatarsal Head

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0043
Author(s):  
Akhil Sharma ◽  
Craig C. Akoh ◽  
Selene G. Parekh
Keyword(s):  
Bone Marrow ◽  
Calcium Phosphate ◽  
Avascular Necrosis ◽  
Early Stage ◽  
Metatarsal Head ◽  
Continuous Variables ◽  
Foot And Ankle ◽  
Exclusion Criteria ◽  
First Metatarsal ◽  
Vas Scores

Category: Midfoot/Forefoot; Other Introduction/Purpose: Patients with subchondral bone marrow lesions often present with arthritic symptoms causing severe discomfort. Recently, subchondroplasty has been offered to treat such patients who suffer from symptoms of bone marrow edema. Calcium phosphate is percutaneously injected into these edematous regions to stabilize damaged bone and aid in healing. Subchondroplasty has been used successfully in the knee for femoral and tibial plateau injuries. However, its use in foot and ankle orthopaedics is relatively limited. This procedure has shown short-term success in patients with painful edema of the talus, as well as patients with early stage avascular necrosis (AVN) in the second MTP joint and the cuboid. Here, we report outcomes of two patients who developed AVN as a result of subchondroplasty in foot and ankle surgery. Methods: A retrospective review of patients was performed in those patients who underwent subchondroplasty in their first metatarsal heads between January 2017 and April 2017. Exclusion criteria included patients lost to follow up. Following implementation of inclusion and exclusion criteria, two patient charts were reviewed. Patients were treated by a single surgeon at the same institution. Data collected included patient demographics (age, laterality, BMI, ASA class, comorbidities), preoperative and postoperative VAS scores, FAOS scores, and imaging. Patients were followed up in clinic for two years following the procedure. Data was then analyzed via mean, standard deviation, median, and range for continuous variables and counts with percentages for categorical data. Results: In both patients, VAS scores increased, and physical exam showed greater tenderness over the affected region. The corresponding MRIs showed development of avascular necrosis in the region of the first metatarsal joint where the subchondroplasty had occurred. Both patients consequently had to undergo revascularization procedures and required further operations to correct the condition. Conclusion: Ultimately, subchondroplasty over the first metatarsal head failed in our patients. Exposure to calcium phosphate exacerbated their condition, resulting in symptomatic AVN. Although literature for subchondroplasty in foot and ankle orthopaedics is limited, preliminary results are unfavorable for use in the first metatarsal joint. Therefore, more long term data needs to be gathered this area before implementing the procedure more widely in foot and ankle surgeries.

scholarly journals Clinical Outcomes and PROMIS Scores with the Use of Synthetic Cartilage Implant (CARTIVA) in Hallux Rigidus at a Non-Industry Sponsored, Multi-Surgeon, Academic Institution

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0013
Author(s):  
Megan C. Chapter ◽  
Jonathan H. Garfinkel ◽  
Taylor Cabe ◽  
Scott Ellis ◽  
Matthew Roberts ◽  
...  
Keyword(s):  
Physical Function ◽  
Clinical Outcomes ◽  
Hallux Rigidus ◽  
Academic Institution ◽  
Foot And Ankle ◽  
Global Function ◽  
One Year ◽  
Radiographic Grading ◽  
Pva Hydrogel

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus is a common arthritic condition seen by foot and ankle specialists. Historically, surgical treatment options have varied from an isolated cheilectomy to first metatarsophalangeal joint fusion. More recently, first metatarsophalangeal (MTP) joint hemiarthroplasty with a polyvinyl alcohol (PVA) hydrogel implant (Cartiva) has become a popular surgical option. A randomized clinical trial sponsored by the manufacturers of the implant showed equivalent pain relief and functional outcome scores at 2 year follow-up when compared to patients undergoing first MTP fusion. In addition, the study reported no bone loss, implant wear or loosening. We retrospectively reviewed 1 year PROMIS score outcomes, clinical outcomes and implant survivorship of patients treated with first MTP hemiarthroplasty with the Cartiva implant at an academic, multi-surgeon center. Methods: We retrospectively reviewed 54 consecutive patients that underwent first MTP hemiarthroplasty with Cartiva for hallux rigidus between January 1, 2017 and December 1, 2017. Minimum follow-up criteria was 1 year, with the average being 1.37 years and maximum follow-up of 1.9 years. The Coughlin radiographic grading of disease severity averaged 2.18 at the time of implantation on a scale of 0 to 4. Surgery was performed by 8 fellowship-trained orthopedic foot and ankle surgeons at an academic institution. Baseline PROMIS scores (physical function, pain interference, global function, global mental, depression) and PROMIS scores acquired at 1 year postoperative were compared and evaluated using the Wilcoxon signed t-test. Clinical outcomes and postoperative complications/events were documented through review of electronic medical records. At the time of the study, 49 patients had reached 1 year follow-up with an average age of 56 (range, 33 - 74) years at the time of implantation. Results: Physical function, pain interference, global function and depression scores all demonstrated clinically and statistically significant improvement at 1 year postoperative. Global mental score did not show significant improvement at the one year follow-up. One patient underwent revision surgery to a 1st MTP fusion for persistent pain. Three patients had postoperative soft tissue swelling requiring prolonged retained sutures. Five patients underwent therapeutic injection with steroid between 2 - 11 months postoperative for persistent discomfort which improved. Five patients were prescribed orthotics between 3 - 6 months follow-up. One patient sustained a metatarsal fracture during the application of the implant requiring ORIF but retained the implant. Implant retention at 1 year was 98% (48/49). No correlation between preoperative radiographic grading and the incidence of poor clinical outcomes. Conclusion: To our knowledge, this is the first study that demonstrates the outcomes of synthetic cartilage implants using a large series of surgeons without affiliation or consultation for the implant company. One year following first MTP hemiarthroplasty with PVA hydrogel implant (Cartiva), functional and pain scores improved significantly, but did not show significant improvement with global mental scores. The implant displayed excellent survivorship at the 1 year time point, with only one patient undergoing surgical revision. Treatment of hallux rigidus with the PVA hydrogel implant - Cartiva, shows improved patient outcomes and has reassuring results at one year.

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