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

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.

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Treatment of Osteochondral Lesion of the First Metatarsal Head: Osteochondral Graft Transplantation Combined With Moberg Osteotomy: Case Report

Foot & Ankle Specialist ◽

10.1177/19386400211001972 ◽

2021 ◽

pp. 193864002110019

Author(s):

Machado A. Bruno ◽

Rassi F. Marcos ◽

Fonseca V. Wagner ◽

Filho V. Wagner

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Alternative Treatment ◽

Osteochondral Lesion ◽

Metatarsal Head ◽

Osteochondral Lesions ◽

Osteochondral Graft ◽

Foot And Ankle ◽

Level Of Evidence ◽

First Metatarsal

Most osteochondral lesions of the first metatarsal head are likely traumatic in etiology. The treatment ranges from microfractures to mosaicplasty. In this case report, we describe a central osteochondral lesion of the first metatarsal head treated with osteochondral graft obtained from the head of the same metatarsal in combination with Moberg osteotomy. After surgical treatment, the patient’s American Orthopedic Foot and Ankle Society Forefoot Scale score improved from 58 to 85, and the range of motion also improved. This technique may be an alternative treatment modality for osteochondral lesions of the first metatarsal. Level of Evidence: Level V

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

Foot & Ankle International ◽

10.1177/10711007211027262 ◽

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.

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Midterm Results of Fresh-Frozen Osteochondral Allografting for Osteochondral Lesions of the Talus

Foot & Ankle International ◽

10.1177/1071100720949861 ◽

2020 ◽

pp. 107110072094986

Author(s):

Chung-Hua Chu ◽

Ing-Ho Chen ◽

Kai-Chiang Yang ◽

Chen-Chie Wang

Keyword(s):

Short Form ◽

Case Series ◽

Osteochondral Allograft ◽

Osteochondral Lesions ◽

Midterm Results ◽

Level Of Evidence ◽

Allograft Transplantation ◽

Fresh Frozen ◽

The Mean

Background: Osteochondral lesions of the talus (OLT) are relatively common. Following the failure of conservative treatment, many operative options have yielded varied results. In this study, midterm outcomes after fresh-frozen osteochondral allograft transplantation for the treatment of OLT were evaluated. Methods: Twenty-five patients (12 women and 13 men) with a mean age 40.4 (range 18-70) years between 2009 and 2014 were enrolled. Of 25 ankles, 3, 13, 4, and 4 were involved with the talus at Raikin zone 3, 4, 6, and 7 as well as one coexisted with zone 4 and 6 lesion. The mean OLT area was 1.82 cm2 (range, 1.1-3.0). The mean follow-up period was 5.5 years (range, 4-9.3). Outcomes evaluation included the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, visual analog scale score, and 12-item Short Form Health Survey (SF-12). Result: AOFAS ankle-hindfoot score increased from 74 preoperatively to 94 at 2 years postoperatively ( P < .001) and the SF-12 physical health component scores increased from 32 to 46 points ( P < .001). Incorporation was inspected in all patients in the latest follow-up, and graft subsidence and radiolucency were observed in 2 and 7 cases, respectively, whereas graft collapse and revision OLT graft were not observed. Bone sclerosis was found in 6 of 25 patients. Conclusion: With respect to midterm results, fresh, frozen-stored allograft transplantation might be an option in the management of symptomatic OLT. Level of Evidence: Level IV, retrospective case series.

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Osteochondral Lesions of the Talus: Few Patients Require Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00059 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0005

Author(s):

Seung-Hwan Park ◽

Sang Gyo Seo ◽

Ho Seong Lee

Keyword(s):

Osteochondral Lesion ◽

Lesion Size ◽

Nonoperative Treatment ◽

Osteochondral Lesions ◽

Sports Activity ◽

Sf 36 ◽

Outcome Scores ◽

The Mean ◽

Analogue Scales

Category: Ankle, Ankle Arthritis Introduction/Purpose: The frequency of progression of osteoarthritis and persistence of symptoms in untreated osteochondral lesion of the talus (OCL) is not well known. We report the outcome of a nonoperative treatment for symptomatic OCL. Methods: This study included 142 patients with OCLs from 2003 to 2013. The patients did not undergo immobilization and had no restrictions of physical activities. The mean follow-up time was 6 (3–10) years. Initial MRI and CT confirmed OCL and showed lesion size, location, and stage of the lesion. Progression of osteoarthritis was evaluated by standing radiographs. In 83 patients, CT was performed at the final follow-up for analyses of the lesion size. We surveyed patients for limitations of sports activity, and Visual Analogue Scales (VAS), AOFAS, and SF-36 were assessed. Results: No patients had progression of osteoarthritis. The lesion size as determined by CT did not change in 69/83 patients, decreased in 5, and increased in 9. The mean VAS score of the 142 patients decreased from 3.8 to 0.9 (p < 0.001), the mean AOFAS ankle–hindfoot score increased from 86 to 93 (p < 0.001), and the mean SF-36 score increased from 52 to 72 (p < 0.001). Only 9 patients reported limitations of sports activity. The size and location of the lesion did not correlate with any of the outcome scores. Conclusion: Nonoperative treatment can be considered a good option for patients with OCL.

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Joint Preservation of the 1st MTP

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000395 ◽

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.

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

Foot & Ankle International ◽

10.1177/107110079801900805 ◽

1998 ◽

Vol 19 (8) ◽

pp. 532-536 ◽

Cited By ~ 69

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.

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00374 ◽

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.

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

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00017 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0001

Author(s):

Kenneth M. Chin ◽

Nicholas S. Richardson ◽

John T. Campbell ◽

Clifford L. Jeng ◽

Matthew W. Christian ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Hallux Valgus ◽

Invasive Surgery ◽

Metatarsal Head ◽

Anatomic Study ◽

Popular Knowledge ◽

Fresh Frozen ◽

The Mean ◽

Anatomic Relationship

Category: Bunion Introduction/Purpose: Minimally invasive surgery for the treatment of hallux valgus deformities has become increasingly popular. Knowledge of the location of the hallux MTP proximal capsular origin on the metatarsal neck is critical for surgeons in planning and executing extra-capsular 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, five female and five male. The mean distances from the central hallux metatarsal head to the MTP capsular origin was 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 orthopaedic surgeons when planning and performing minimally invasive distal metatarsal osteotomies for the correction of hallux valgus.

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Investigation of factors related to the occurrence of osteochondral lesions of the talus by 3D bone morphology of the ankle

The Bone & Joint Journal ◽

10.1302/0301-620x.100b11.bjj-2018-0346.r1 ◽

2018 ◽

Vol 100-B (11) ◽

pp. 1487-1490 ◽

Cited By ~ 1

Author(s):

A. Teramoto ◽

H. Shoji ◽

H. Kura ◽

Y. Sakakibara ◽

T. Kamiya ◽

...

Keyword(s):

Surface Area ◽

Osteochondral Lesion ◽

Opening Angle ◽

Control Group ◽

Osteochondral Lesions ◽

Medial Malleolus ◽

3D Ct ◽

Bone Morphology ◽

The Mean ◽

Area And Volume

Aims The aims of this study were to evaluate the morphology of the ankle in patients with an osteochondral lesion of the talus using 3D CT, and to investigate factors that predispose to this condition. Patients and Methods The study involved 19 patients (19 ankles) who underwent surgery for a medial osteochondral lesion (OLT group) and a control group of 19 healthy patients (19 ankles) without ankle pathology. The mean age was significantly lower in the OLT group than in the control group (27.0 vs 38.9 years; p = 0.02). There were 13 men and six women in each group. 3D CT models of the ankle were made based on Digital Imaging and Communications in Medicine (DICOM) data. The medial malleolar articular and tibial plafond surface, and the medial and lateral surface area of the trochlea of the talus were defined. The tibial axis-medial malleolus (TMM) angle, the medial malleolar surface area and volume (MMA and MMV) and the anterior opening angle of the talus were measured. Results The mean TMM angle was significantly larger in the OLT group (34.2°, sd 4.4°) than in the control group (29.2°, sd 4.8°; p = 0.002). The mean MMA and MMV were significantly smaller in the OLT group than in the control group (219.8 mm2, sd 42.4) vs (280.5 mm2, sd 38.2), and (2119.9 mm3, sd 562.5) vs (2646.4 mm3, sd 631.4; p < 0.01 and p = 0.01, respectively). The mean anterior opening angle of the talus was significantly larger in the OLT group than in the control group (15.4°, sd 3.9°) vs (10.2°, sd 3.6°; p < 0.001). Conclusion 3D CT measurements showed that, in patients with a medial osteochondral lesion of the talus, the medial malleolus opens distally, the MMA and MMV are small, and the anterior opening angle of the talus is large. This suggests that abnormal morphology of the ankle predisposes to the development of osteochondral lesions of the talus. Cite this article: Bone Joint J 2018;100-B:1487–90.

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Strength of Fixation Constructs for Basilar Osteotomies of the First Metatarsal

Foot & Ankle ◽

10.1177/107110079201300904 ◽

1992 ◽

Vol 13 (9) ◽

pp. 509-514 ◽

Cited By ~ 58

Author(s):

George J. Lian ◽

Keith Markolf ◽

Andrea Cracchiolo

Keyword(s):

Bending Strength ◽

Bending Moment ◽

Metatarsal Head ◽

Fixation Strength ◽

Osteotomy Site ◽

Test Machine ◽

First Metatarsal ◽

Single Screw ◽

Fresh Frozen ◽

K Wires

Twenty-four pairs of fresh-frozen human feet had a proximal osteotomy of the first metatarsal that was fixed using either screws, staples, or K wires. Each metatarsal was excised and the specimen was loaded to failure in a cantilever beam configuration by applying a superiorly directed force to the metatarsal head using an MTS ser-vohydraulic test machine. Specimens with a crescentic osteotomy that were fixed using a single screw demonstrated higher mean failure moments than pairs that were fixed with four staples or two K wires; staples were the weakest construct. All specimens fixed with staples failed by bending of the staples without bony fracture; all K wire constructs but one failed by wire bending. Chevron and crescentic osteotomies fixed with a single screw demonstrated equal bending strengths; the bending strength of an oblique osteotomy fixed with two screws was 82% greater than for a crescentic osteotomy fixed with a single screw. Basilar osteotomies of the first metatarsal are useful in correcting metatarsus primus varus often associated with hallux valgus pathology. Fixation strength is an important consideration since weightbearing forces on the head of the first metatarsal acting at a distance from the osteotomy site subject the construct to a dorsiflexion bending moment, as simulated in our tests. Our results show that screw fixation is the strongest method for stabilizing a basilar osteotomy. Based upon the relatively low bending strengths of the staple and K wire constructs, we would not recommend these forms of fixation. If, for some reason, these are the only methods of fixation available, then use of a short leg cast and limited weightbearing for several weeks postoperatively should be considered.

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