1st MPJ arthrofibrosis

NewsBot · Aug 15, 2006

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Arthroscopic Release of First Metatarsophalangeal Arthrofibrosis
Arthroscopy: The Journal of Arthroscopic & Related Surgery
Volume 22, Issue 8 , 1 August 2006, Pages 906.e1-906.e4

Various degrees of first metatarsophalangeal joint arthrofibrosis frequently occur in patients with bunion surgery or big toe trauma. In those patients with functional limitation who fail to respond to conservative treatment, surgery is indicated. We describe here an arthroscopic approach to first metatarsophalangeal release that is designed to improve functional results. Dorsomedial and dorsolateral portals are established at the medial and lateral sides of the extensor hallucis longus tendon. Through these 2 portals, the dorsal capsule is released and the medial and lateral joint gutters can be cleared up. The metatarsosesamoid compartment is approached through the straight medial portal and the working portal, the latter of which is located 4 cm proximal to the joint line between the abductor hallucis tendon and the medial head of the flexor hallucis brevis. Under visualization through the medial portal, adhesions around the sesamoid apparatus can be debrided with a shaver through the working portal. This completes the release of joint circumference and improves the motion range of the joint.
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NewsBot · Aug 7, 2015

Joint Manipulation Under Anesthesia for Arthrofibrosis After Hallux Valgus Surgery
Catherine Feuerstein, DPM, Lowell Weil Jr., DPM, MBA, Lowell Scott Weil Sr., DPM, Erin E. Klein, DPM, MS, Nicholas Argerakis, DPM, Adam E. Fleischer, DPM, MPH
JFAS; Article in Press

Arthrofibrosis is a known complication of hallux valgus surgery. Joint manipulation under anesthesia has been studied for adhesive capsulitis of the shoulder; however, a paucity of published data exists on the use of this modality in the foot and ankle. The purpose of the present study was to investigate the outcomes of first metatarsophalangeal joint manipulation for arthrofibrosis that occurred as a complication of bunion surgery. The study population consisted of patients attending a single foot and ankle specialty clinic who were evaluated for arthrofibrosis after bunion surgery. Patients who underwent joint manipulation under anesthesia were asked to complete a research visit in which a clinical examination was performed and the presence and severity of joint pain were assessed. A total of 38 patients (34 females, 4 males, 53 feet), with a mean age of 55.7 ? 11.8 (range 30 to 83) years, agreed to participate. The mean follow-up period was 6.5 ? 3.4 (range 1 to 17) years. The visual analog scale scores improved significantly from baseline to the final follow-up visit (baseline 6.5 ? 1.5, range 2 to 10; final follow-up visit 2.3 ? 1.5, range 0 to 6; p < .001). Furthermore, joint motion had increased significantly (p < .001) for both dorsiflexion and plantar flexion at the final follow-up examination. The final range of motion (dorsiflexion, r = −0.431, p = .002; plantar flexion, r = −0.494, p < .001) correlated highly with patient self-reported pain in the first metatarsophalangeal joint. Our findings suggest that joint manipulation could be a useful modality for increasing first metatarsophalangeal joint mobility and alleviating pain in patients who experience arthrofibrosis after surgical correction of hallux valgus.
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