Osteochondral Lesions in Surgically Treated Hallux Valgus

NewsBot · Apr 15, 2014

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Osteochondral Lesions in Surgically Treated Hallux Valgus
James R. Jastifer, et al
Foot & Ankle International April 7, 2014

Background: Patient dissatisfaction following surgical correction of hallux valgus remains a clinical problem. The aim of this study was to investigate articular erosion patterns of the first metatarsal head in patients with hallux valgus, to evaluate if the cartilage damage was associated with the degree of hallux valgus deformity, and to prospectively evaluate the effect on patient outcomes.

Methods: Fifty-six consecutive feet undergoing surgical correction for hallux valgus were prospectively enrolled and followed for 24 months postoperatively. In addition to clinical and radiographic examinations, intraoperative measurements were obtained to quantify osteochondral lesion location, size, and grade of the first metatarsal head cartilage.

Results: Fifty-one of 56 feet (91%) had osteochondral lesions. The mean number of zones affected was 2.9, and the mean maximum International Cartilage Repair Society (ICRS) scale lesion grade was 2.9 out of 4. A total of 44/56 (79%) completed a minimum of 24 months of follow-up. The grade of the lesion and the extent of the lesion did not have a strong correlation with the radiographic measures or clinical outcome scores.

Conclusions: This study showed a high prevalence of osteochondral lesions in patients undergoing operative correction of hallux valgus. Since the grade and the extent of the lesions did not have a strong correlation with the severity of the deformity or the clinical outcome, the significance of these lesions remains unknown
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NewsBot · Apr 30, 2017

Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint.
Kuyucu E et al
J Orthop Surg Res. 2017 Apr 27;12(1):68. doi: 10.1186/s13018-017-0562-7.

BACKGROUND:
Although arthroscopic surgical treatment of the first metatarsophalangeal (MTP) joint involves painful sesamoid excision, synovectomy, debridement, and partial cheilectomy, no gold standard treatment technique has been defined in the literature for hallux rigidus and focal osteochondral lesions. This study aimed to assess the arthroscopic treatment for early grade focal osteochondral lesions of the first MTP joint and to determine the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in a group of patients who failed conservative treatment.
METHODS:
This prospective study included 14 patients with hallux rigidus and focal osteochondral lesions of the first MTP joint who underwent surgery in 2014 and were followed on a regular basis thereafter.
RESULTS:
The patients had mean preoperative VPS (visual pain score) and AOFAS (American Orthopedic Foot and ankle Society)-Hallux scores of 8.14 ± 0.86 SD and 48.64 ± 4.27, respectively; the corresponding postoperative values of both scores were 1.86 ± 0.66 SD and 87.00 ± 3.70. Both VPS and AOFAS-Hallux scores changed significantly.
DISCUSSION:
In this prospective study, we explored the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in patients with focal osteochondral lesions of the first MTP joint. Our results showed significant improvements in VPS and AOFAS scores with this treatment.
CONCLUSIONS:
An arthroscopic microhole drill technique can be used with impressive functional scores and without any complications in patients who failed conservative therapy for hallux rigidus with focal chondral injury.
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NewsBot · Jun 24, 2017

Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint.
Kuyucu E et al
J Orthop Surg Res. 2017 Jun 21;12(1):95. doi: 10.1186/s13018-017-0569-0.

BACKGROUND:
Although arthroscopic surgical treatment of the first metatarsophalangeal (MTP) joint involves painful sesamoid excision, synovectomy, debridement, and partial cheilectomy, no gold standard treatment technique has been defined in the literature for hallux rigidus and focal osteochondral lesions. This study aimed to assess the arthroscopic treatment for early-grade focal osteochondral lesions of the first MTP joint and to determine the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in a group of patients who failed conservative treatment.
METHODS:
This prospective study included 14 patients with hallux rigidus and focal osteochondral lesions of the first MTP joint who underwent surgery in 2014 and were followed on a regular basis thereafter.
RESULTS:
The patients had mean preoperative VPS (visual pain scale) and AOFAS (American Orthopedic Foot and Ankle Society)-Hallux scores of 8.14 ± 0.86 SD and 48.64 ± 4.27, respectively; the corresponding postoperative values of both scores were 1.86 ± 0.66 SD and 87.00 ± 3.70, respectively. Both VPS and AOFAS-Hallux scores changed significantly.
DISCUSSION:
In this prospective study, we explored the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in patients with focal osteochondral lesions of the first MTP joint. Our results showed significant improvements in VPS and AOFAS scores with this treatment.
CONCLUSIONS:
An arthroscopic microhole drill technique can be used with impressive functional scores and without any complications in patients who failed conservative therapy for hallux rigidus with focal chondral injury.
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NewsBot · Nov 8, 2017

First Metatarsal Head Osteochondral Defect Treatment With Particulated Juvenile Cartilage Allograft Transplantation: A Case Series
Bryan Van Dyke, DO, Gregory C. Berlet, MD, Justin L. Daigre, MD, ...
Foot & Ankle International November 7, 2017

Background:
Focal damage to articular cartilage, also called an osteochondral defect (OCD), can be a cause of pain and decreased range of motion. Recent advancements have led to transplantation techniques using particulated juvenile articular cartilage allograft. This technique has been applied to the first metatarsal head to a very limited degree, with no published results to our knowledge. The aim of this study was to review the clinical results of patients who underwent particulated juvenile cartilage allograft implantation for first metatarsal head OCDs.

Methods:
We performed a retrospective consecutive case series study. Nine patients, at an average age of 41 years, were treated for symptomatic focal osteochondral defects of the first metatarsal head with particulate cartilage grafting from 2010 to 2016. Patients were contacted by phone to assess interest in returning to the office for follow-up, where weightbearing radiographs of the foot were obtained and a foot examination was performed.

Results:
At an average follow-up of 3.3 years, 7 of 9 patients reported no pain with recreational activities and no patient required further operations. This patient cohort was physically active, with 6 of 9 listing running as a regular activity. The average overall American Orthopaedic Foot & Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale questionnaire score was 85 (maximum 100), AOFAS pain 35.6 (maximum 40), and AOFAS function 40.1 (maximum 45). Patient satisfaction surveys correlated with the AOFAS scores and revealed that 7 of 9 patients were very satisfied with their results, 1 was satisfied, and 1 patient was very dissatisfied.

Conclusion:
Particulated juvenile cartilage allograft transplantation is a promising treatment option for symptomatic first metatarsophalangeal focal articular cartilage lesions. Further study is needed to demonstrate which lesions respond better to this type of cartilage graft versus traditional marrow-stimulating procedures
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NewsBot · Jul 20, 2022

Arthroscopic Accessibility of the First Metatarsophalangeal Joint for Osteochondral Defects of the Metatarsal Head by Two-portal Technique - Comparing Joint Distraction and Plantarflexion
KatharinaCzerny et al
Foot and Ankle Surgery 19 July 2022

Background
Several techniques and approaches for first metatarsophalangeal (MTP1) joint arthroscopy have been reported, where joint accessibility plays a key role. This study aimed to evaluate differences in arthroscopic accessibility of the first metatarsal head (MTH1) comparing non-invasive distraction and maximum plantarflexion in a two-portal approach.

Methods
Forty fresh-frozen lower leg specimens were included and divided into a distraction group (D-group) and a plantarflexion group (PF-group). A two-portal technique (1.9mm-30°-scope) was used for arthroscopy, maximum reach at the MTH1 was marked. Following arthroscopy, specimens were dissected and examined for iatrogenic injuries. The reached area at the chondral surface was pinned and accessibility calculated.

Results
Accessibility of the MTH1 was 58.03%±13.64 (D-group) and 55.93%±10.30 (PF-group, p=0.51). The dorsomedial hallucal nerve was injured in one specimen (2.5%).

Conclusion
Maximum plantarflexion showed no difference in arthroscopic MTP1 joint accessibility compared to non-invasive distraction in a two-portal approach. During dorsomedial portal placement, the dorsomedial hallucal nerve is at risk for iatrogenic injury.
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NewsBot · Jun 5, 2023

SURGICAL MANAGEMENT OF OSTEOCHONDRAL LESIONS OF THE FIRST METATARSAL HEAD: A SYSTEMATIC REVIEW
Elena Artioli et al
Foot and Ankle Surgery; 1 June 2023

Background
Treating osteochondral lesions of the first metatarsal head can help reducing pain and preventing end-stage arthritic cartilage degeneration and hallux rigidus. Several surgical techniques have been described, but no clear indications are reported. This systematic review aims to offer an overview of the current surgical treatments for focal osteochondral lesions of the first metatarsal head.

Methods
The selected articles were examined to extract data about population, surgical technique, and clinical outcomes.

Results
Eleven articles were included. Mean age at surgery was 38,2 years. Osteochondral autograft was the most used technique. After surgery, an improvement was achieved in AOFAS, VAS, and hallux dorsiflexion but not in plantarflexion.

Conclusion
There is limited evidence and knowledge regarding the surgical management of the first metatarsal head osteochondral lesions. Various surgical techniques have been proposed, drawn from other districts. Good clinical results have been reported. Further high-level comparative studies are necessary to design an evidence-based treatment algorithm.
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NewsBot · Jul 31, 2023

Needle Arthroscopy for Osteochondral Lesions of the First Metatarsophalangeal Joint: A Standardized Approach
Alex B. Walinga et al
Arthroscopy Techniques; Volume 12, Issue 7, July 2023, Pages e1015-e1019

Cartilage and osteochondral lesions of the first metatarsophalangeal (MTP-1) joint are characterized by pain during weight bearing and walking. The lesions often require surgical intervention(s). Arthroscopic bone marrow stimulation may be considered the preferred operative intervention for small lesions. Technological advances, patient preferences, and economic considerations combine to foster the development of minimally invasive needle arthroscopic procedures. This technical note presents and highlights our minimally invasive surgical technique for needle arthroscopic treatment through bone marrow stimulation for osteochondral lesions of the MTP-1 joint.
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NewsBot · Aug 1, 2023

Case Report of an Osteochondral Lesion of the First Metatarsal Head in an Adolescent Patient Treated by Autograft Mosaicplasty: Surgical Technique and Decision-Making Rationale
Joana Arcângelo et al
Case report | Volume 13 | Issue 07 | JOCR July 2023 | Page 20-26

Introduction: First metatarsophalangeal (MTP) joint mobility is critical to a normal gait pattern; therefore, osteochondral defects (OCDs) of the first metatarsal head should be treated promptly to avoid functional limitation and progression to hallux rigidus. <15 cases of OCDs of the first MTP joint in the pediatric population, predominantly adolescents, have been published so far. The purpose of this article is to present a rare case of an adolescent first MTP joint OCD treated by the technique of autograft osteochondral mosaicplasty, which has been commonly used for OCDs of the knee and talus but scarcely described for the first MTP joint.

Case Report: The case of a 13-year-old male futsal player with a post-traumatic 50 mm2 OCD of the first metatarsal head is presented. The Osteochondral Autograft Transfer System® (Arthrex Inc™, Naples, FL) was used to harvest a 10-mm diameter donor plug from the medial ipsilateral femoral condyle, then delivered to the first metatarsal head. At the 6-month follow-up, physical activity had been resumed with no pain or significant mobility limitation and an improvement of the American Orthopedic Foot and Ankle Society hallux score of 54–95 points. At the same time, a follow-up magnetic resonance showed complete incorporation of the osteochondral graft without bone edema or subchondral osteonecrosis.

Conclusion: Treatment for osteochondral lesions, regardless of their location, aims to restore function by recreating the articular congruity reducing the potential for a progressive degenerative process. Multiple surgical treatment options exist for OCDs of the first metatarsal head. The treatment decision must take into consideration both patient factors and lesion factors. Based on this, a literature revision and treatment decision rationale are presented. This case demonstrated that an osteochondral transplant could be a reasonable treatment option for a traumatic, full-thickness OCD of the first metatarsal head in adolescent patients.
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