Is adjunction of advanced platelet-rich fibrin (A-PRF) useful in first metatarsophalangeal joint arthrodesis? A retrospective cohort study

PurposeFirst metatarsophalangeal (MTPJ1) fusion represents the gold standard treatment for end-stage hallux rigidus (HR). The aim of this study was to assess efficacy and safety of A-PRF in promoting union after MTPJ1 arthrodesis. Our hypothesis was that the use of A-PRF may reduce the non-union rate and the time to fusion in the treatment of HR.Methods14 patients that had undergone MTPJ1 arthrodesis with A-PRF adjunction with 21 standard MTPJ1 fusions were retrospectively reviewed. The fusion rate and time to fusion (clinically and radiographically) were assessed at 6, 12 weeks and at the longest follow-up; the clinical status at final follow-up through forefoot AOFAS, EQ5d, SEFAS and VAS-pain scores; the complication rate.ResultsAt 6-weeks, bony union was achieved in 100% of patients in the A-PRF group compared to 70% in the control group, but this difference was not statistically significant (p = 0.22). At final follow-up (41 months), union rate in the control group reached 92% (one non-union). AOFAS, VAS and EQ-5d scores showed similar results for the two groups (p = 0.86, p = 0.12 and p = 0.61, respectively); only SEFAS score revealed a difference favoring the A-PRF group (p = 0.04). No revision surgery or complication was recorded in any group.ConclusionsA tendency for increased union rate was mainly found at 6 weeks in patients treated with MTPJ1 fusion associated to A-PRF compared to isolated fusion. The use of A-PRF was not associated with an increased complication rate at final follow-up.Level of evidenceLevel 3, therapeutic study, retrospective comparative study.     

Minimal resection interposition arthroplasty of the first metatarsophalangeal joint

BackgroundInterposition arthroplasty of the first metatarsophalangeal (MTP) joint is a viable alternative to fusion in patients with advanced hallux rigidus. The purpose of this study is to evaluate the midterm results of a modification of the technique.MethodsCase series of 18 interposition arthroplasties were performed on 13 female patients with Grade III–IV hallux rigidus. The technique included cheilectomy, bunionectomy when needed, minimal resection of the base of the proximal phalanx and interposition of a fascia lata allograft in the first metatarsophalangeal joint. Mean follow up was nine years (range 75–136 months). Patients were evaluated according to the AOFAS score, the ability to tip toe and their subjective satisfaction.ResultsThere was a significant difference between preoperative (mean 43.2, range 15–83) and postoperative (mean 77.3, range 40–100) AOFAS scores (p < 0.001). The patients were able to tip toe on 12 of the 18 operated feet and 9 of the 13 patients were satisfied from the operation. All dissatisfied patients had a coexistent hallux valgus deformity.ConclusionsThe technique had satisfactory midterm outcomes in older patients with advanced hallux rigidus without hallux valgus. Advantages of the method are the preservation of tip toe function in most patients and a technically easy conversion to fusion when needed.     

Cheilectomy With Decompression Osteotomy for Treatment of Hallux Limitus and Rigidus: A Retrospective Study With 5-Year Outcomes

We examined outcomes following metatarsophalangeal joint cheilectomy with decompression osteotomy to evaluate the efficacy of this technique for treatment of hallux limitus/rigidus. At a minimum follow-up of 5 years, we identified 94 patients who fit the inclusion criteria. Chart review was performed to obtain range of motion (ROM) of the first metatarsophalangeal joint (MTPJ) preoperatively and at 6 weeks, 6 months, and 5 years postoperatively. Additionally, time to traditional shoe gear return, need for revision arthrodesis, radiographic findings, and postoperative visual analog scale (VAS) pain scores were reviewed. Statistical analysis was conducted by 1-way analysis of variance with post-hoc analysis and independent sample t-test. At an average follow-up of 6.3 ± 0.9 years, 42.3% (33/78) of females and 25.0% (4/16) of males reported limited ROM of the first MTPJ with 5 patients requiring first MTPJ arthrodesis. MTPJ ROM improved on average from 11.0° to 36.3° by 5-year minimum follow-up after surgery (p < .001). Analysis of variance revealed a significant difference of the preoperative ROM when compared to all postoperative time points (F[3,368] = 69.4, p < .001). Mean postoperative VAS pain scores after decompression osteotomy of the 5 patients who required MTPJ fusion were higher when compared to the rest of the patient cohort at final follow-up (7.4 ± 0.6 vs 1.5 ± 1.3; p < .001). Cheilectomy with decompression osteotomy for treatment of hallux limitus/rigidus leads to satisfactory long-term outcomes.     

Radiographic Outcomes Following Primary Arthrodesis of the First Metatarsophalangeal Joint in Hallux Abductovalgus Deformity

The purpose of this study was to evaluate the radiographic outcomes of primary metatarsophalangeal joint arthrodesis for hallux abductovalgus deformities. Between January 2004 and March 2009, 56 consecutive patients (58 feet) underwent primary arthrodesis of the metatarsophalangeal joint (MTPJ) for severe hallux abductovalgus deformity and or hallux rigidus. Results were assessed by primary radiographic outcome measurements (hallux valgus and first-second intermetatarsal angle). Overall, the mean hallux valgus (HA) angle improved significantly from 31.9° to 13.4° (P < .01). The mean first-second intermetatarsal (IM) angle correction was also signficantly reduced from 14.0° to 9.7° (P < .01). When separated by deformity group (mild, moderate, and severe), the mean hallux valgus and first-second intermetatarsal angles demonstrated statistically significant correction in all groups when comparing preoperative and postoperative values (P < .01). Primary arthrodesis provides predictable radiographic outcomes and effective correction for patients with differing severity of hallux abductovalgus deformity and arthritis of the first metatarsophalangeal joint. A separate proximal osteotomy for severe metatarsus primus varus correction may not be necessary because of the correction achieved at the metatarsophalangeal joint arthrodesis level. The results of this study demonstrate that as the severity of the preoperative deformity increases, the amount of postoperative radiographic (HA and IM angle measurement) correction after MTPJ arthrodesis will improve correspondingly.     

Radiographic evaluation of first MTP joint arthrodesis for severe hallux valgus: Does the introduction of a lag screw improve union rates and correction of the intermetatarsal angle?

BackgroundFirst metatarsophalangeal (MTP-1) joint fusion is a reliable method for the correction of various deformities including hallux valgus and hallux rigidus. Ideal constructs provide high rates of fusion in desired alignment. The present study examines the union rates, as well as the change in dorsiflexion angle during the follow up period in patients who underwent MTP-1 fusion with a dorsal locking plate and a lag screw, versus patients fused with a dorsal locking plate alone.MethodsThis is a retrospective review of 99 feet undergoing MTP-1 fusion. Joints were fused using either a dorsal locking plate alone or a lag screw plus a dorsal locking plate. Union was determined radiographically during the follow up period. Suspected nonunions were confirmed with CT. Dorsiflexion angles were radiographically measured at first post-operative visit and at final follow up.ResultsThere were 36 patients in the lag screw plus dorsal plate group, and 63 in the dorsal plate group. Mean follow up was 12.9 months (Range: 12–33.5 months). The dorsal plate plus lag screw group had a significantly lower change in mean dorsiflexion angle (0.57° ± 5.01°) during the post-operative period compared to the dorsal plate group at final follow up versus the dorsal plate group (6.73° ± 7.07°).ConclusionThe addition of a lag screw to a dorsal locking plate for MTP-1 arthrodesis may offer improved stability of the joint in the sagittal plane over time compared to a dorsal plate alone.Level of evidenceRetrospective level III evidence.     

Minimally invasive arthrodesis of the first metatarsophalangeal joint for hallux rigidus

BackgroundFirst metatarsophalangeal joint arthrodesis plays a significant role in the management of symptomatic hallux rigidus. Several open and one percutaneous technique have been described in the literature. The authors present a minimally invasive technique, not previously published in the UK with patient-reported outcomes.MethodsA total of 26 cases of are presented in this prospective, continuous series. Clinical outcome and patient satisfaction were assessed by the Manchester-Oxford Foot Questionnaire (MOXFQ) preoperatively and at most recent follow up (maximum 20 months). Radiographic and clinical evaluation of fusion was also assessed with a fusion rate of 93%.ResultsThe MOXFQ score for cases where fusion was achieved improved from a mean of 42 points to 18 points at last follow up (p < 0.05). Patient satisfaction was overall very good.ConclusionsThis minimally invasive technique is simple and can achieve results similar or better than open techniques in experienced hands. Postoperative care requirements are minimal and both clinical and patient-reported outcome show significant improvement in this series.     

Distal oblique osteotomy versus cheilectomy for moderate-advanced hallux rigidus: A 2-year propensity-score-matched study

BackgroundThe surgical treatment of moderate-advanced hallux rigidus is controversial. Cheilectomy is widely used but has recurrence rates of up to 30%. Dorsal oblique metatarsal osteotomy (DOO) has also shown good results, however, there is no study comparing outcomes of the DOO against cheilectomy.MethodsThis was a retrospective propensity score matched study based on registry data from a single tertiary institution. Between 2007 and 2017, all patients who had undergone dorsal cheilectomy or DOO for hallux rigidus were included. Patients with previous foot surgery, revision surgeries, and concomitant surgical procedures were excluded. Clinical outcomes, complication rates, revision rates and patient satisfaction were assessed at 2 years postoperatively.ResultsThere were 44 patients (34 cheilectomy, 10 DOO). After propensity score matching, 17 cheilectomy and all 10 DOO cases were selected for comparison. Patients in both groups had a significant improvement in visual analogue pain scores (VAS) and AOFAS 1st toe scores 2-years post-operatively (P < 0.001) with high levels of post-operative satisfaction (85.1%). Overall there were no statistically significant differences in post-operative scores, improvement in scores, complication rates, revision rates, and levels of patient satisfaction between groups.ConclusionsBoth the DOO and cheilectomy give similarly good outcomes for moderate-advanced hallux rigidus. Further studies are needed to elucidate differences in indications for each procedure.     

Shortening Scarf osteotomy for correction of severe hallux valgus. Does shortening affect the outcome?

BackgroundTranslation and shortening of Scarf osteotomy allows correction of severe hallux valgus deformity. Shortening may result in transfer metatarsalgia.AimTo evaluate outcome of patients undergoing shortening Scarf osteotomy for severe hallux valgus deformities.Materials and MethodsFifteen patients (20 feet, mean age 58 years) underwent shortening Scarf osteotomy for severe hallux valgus deformities. Outcomes were pre and postoperative AOFAS scores, IM and HV angles, patient satisfaction.ResultsMean follow-up was 25 months (range 22–30). The IM angle improved from a median of 18.60 (range 13.4–26.20) preoperatively to 9.70 (range 8.0–13.70) postoperatively (8.9; 95% CI = 7.6–10.3; p < 0.001). The HV angle improved from a mean of 43.2 (range 27.4–68.2) preoperatively to 13.6 (range 3.0–37.4) postoperatively (29.6; 95% CI = 26.1–33.2; p < 0.001).The median AOFAS score improved from 29.2 (range 14–60) preoperatively to 82.2 (range 55–100) postoperatively (53.0; 95% CI = 48.0–58.5; p < 0.001). All patients rated their satisfaction as either satisfied or very satisfied. None had symptoms of transfer metatarsalgia at final follow-up. All osteotomies united.ConclusionsShortening Scarf osteotomy is a viable option for treating severe hallux valgus deformities with no transfer metatarsalgia.     

Bunionette deformity corrected with “shortening” scarf osteotomy of the fifth metatarsal: mid-term results of a 34-cases

BackgroundThe aim of this study was to evaluate the clinical and radiological outcomes (in mid-term) after “shortening” scarf osteotomy of the fifth metatarsal for the treatment of bunionette deformity.MethodsWe retrospectively reviewed the functional score — American Orthopaedic Foot and Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale, radiographic results — 4th/5th intermetatarsal angle, varus angle of the 5th metatarsophalangeal joint and complications in a consecutive series of 34 feet (27 patients) with bunionette. Nine males and 18 females (mean age: 45 years) were included in the study. Three males and four females were operated bilaterally The patients were operated on between 2004 and 2015, and evaluated during 2017.ResultsThe average AOFAS score improved from 59.4 to 93 at a mean follow-up of 7.2 years. The 4th/5th intermetatarsal angle and varus angle of the 5th metatarsophalangeal joint decreased from 13.9°/19.5° preoperatively to 6°/5.9° at final follow-up. No neurovascular damage was recorded. Complications arose in five feet (14.7%): delayed union (n = 1), early infection (n = 1), distal screw migration (n = 1), asymptomatic non-union (n = 1), transverse metatarsalgia (n = 1). The osteotomy healed within less than three months except twoo (delayed union, non-union). Three feet needed additional surgery: screw removal (n = 2), Weil osteotomy of 2nd–4th metatarsals (n = 1).Conclusions“Shortening” scarf osteotomy is an acceptable, but not complication-free, treatment option for the bunionette deformity and offers promising results in the mid-term.     

Hallux rigidus: A cross-sectional study to evaluate clinical parameters

BackgroundHallux rigidus (HR) is a common condition with history and physical examination used to help evaluate pathology, grade clinical changes and to inform treatment.MethodA cross-sectional study was undertaken to evaluate the demographics of and clinical parameters encountered in HR. In 110 subjects (180 feet) aged 18–70 years (mean 52 years) a standardized history and physical examination was undertaken. Clinical parameters associated with HR were evaluated. The Foot Health Status Questionnaire (FHSQ) was used to measure health-related quality-of-life dimensions.ResultsSeventy (64%) subjects had bilateral HR and 73 (66%) were female. Mean HR onset was 44 (14–68 years) years and median HR duration 6 years (1–33 years). A history of 1st MTPJ trauma presented in 22% of subjects; 74% of whom had unilateral HR. Eighty-four (47%) feet had pes planus based on a positive Foot Posture Index. A correlation between pes planus and 1st MTPJ pain was found (r = 0.84, p = 0.05). In 74% of feet, hallux abductus interphalangeus angle (HAI°) was greater than normal (≤10°). A correlation between HAI and reduced 1st MTPJ ROM was found (r = 0.92, p = 0.05). Second toe length was the same as the hallux in 111 feet (62%). A correlation between valgus hallucal rotation and 1st MTP joint pain in HR was found (r = .78, p = .05). A positive relationship was found between 2nd toe length and 1st MTPJ pain (p = 0.001 < 0.05). A correlation between hallucal interphalangeal joint (IPJ) hyperextension and 1st MTPJ pain was found (r = 0.78, p = 0.01). A positive relationship was found between lesser MTPJ pain and supination at propulsion (p < 0.001). There was no evidence of Achilles tendon contracture. The FHSQ results concur with clinical findings.ConclusionsHR was associated with female gender, bilateral involvement, older age groups, increased HAI°, 2nd toe length similar to hallux, hallucal IPJ hyperextension, lesser MTP joint pain, flat foot and certain gait alterations. HR was not associated with Achilles tendon tightness or footwear. The content validity of clinical parameters of HR needs to be established by formal research prior to their inclusion in a classification of HR.     

Anteromedialisation tibial tubercle osteotomy for recurrent patellar instability in young active patients: A retrospective case series

IntroductionRecurrent patellar instability can be a source of continued pain and functional limitation in the young, active patient population. Instability in the setting of an elevated tibial tubercle–trochlear groove (TT–TG) distance can be effectively managed with a tibial tubercle osteotomy. At the present time, clinical outcome data are limited with respect to this surgical approach to patellar instability.MethodsA retrospective chart review was performed to identify all cases of tibial tubercle osteotomy for the management of patellar instability performed at our institution with at least 1 year of post-operative follow-up. Patient demographic information was collected along with relevant operative data. Each patient was evaluated post-operatively with their outcomes assessed utilising a visual analogue score of pain, patient satisfaction, Tegner Activity Scale and Kujala score.Results31 patients (23 females and 8 males) with mean age of 27 years (17–43 years) and a mean BMI of 26.3 kg/m² (19.6–35.8) at time of surgery who underwent a tibial tubercle osteotomy as treatment for recurrent patellar instability were identified. The cohort had a mean follow up of 4.4 years (1.5–11.8 years). The mean pre-operative TT–TG distance was 18 mm (10–22 mm). The mean VAS pain score demonstrated a significant improvement from 6.8 (95% CI 6.1–7.5) at baseline to 2.8 (95% CI 1.9–3.7) post-operatively (p < 0.001). The Tegner score improved from 4.1 (95% CI 3.4–4.8) pre-operatively to 5.2 (95% CI 4.5–5.9) at the time of final follow up (p < 0.04). The Kujala score for anterior knee pain improved postoperatively from 62 (95% CI 55.4–68.7) to 76.5 (95% CI 69.5–83.5) at final follow up (p < 0.001). 26 of the 31 patients (83.8%) had good to excellent Kujala scores. 27 of 31 patients (87.1%) reported that they would undergo the procedure again if necessary.ConclusionFor the management of recurrent patellar instability in the setting of an increased tibial tubercle–trochlear groove distance, a corrective tibial tubercle osteotomy is an effective treatment modality to reliably prevent patellar instability while reducing pain and improving function in this cohort of young, active patients.     

Preliminary investigation on the reduction of plantar loading pressure with different insole materials (SRP – Slow Recovery Poron®, P – Poron®, PPF – Poron® + Plastazote,firm and PPS – Poron® + Plastazote,soft)

BackgroundThe aim of this study is to investigate the amount of pressure reduction for different padding and insole materials commonly used in the podiatry clinic.MethodsPlantar pressure were taken for 5 subjects without insoles fitted (BF) in their daily sports shoes, and thereafter with 4 pairs of simple insoles (6.4 mm thick) each as follow: SRP – Slow Recovery Poron^®, P – Poron^®, PPF – Poron^® + Plastazote (firm) and PPS – Poron^® + Plastazote (soft). In addition, subjects were also tested with semi-compressed felt (SCF) padding with a 1st metatarsophalangeal joint (MTPJ) aperture cut-out bilaterally. Minimum, maximum, mean pressure and peak pressure at the hallux, 1st, 2nd, 3rd/4th and 5th MTPJ across both feet were analysed. Repeated measures ANOVA with post hoc Bonferroni paired wise comparison was used to test for any statistical significance at the 95% confidence level for all pressure data.ResultsPPF was significant in reducing the minimum (p < 0.005) and mean pressure (p < 0.03) when compared to BF. This accounted for approximately 28% and 27% pressure reduction in minimum and mean pressure respectively. Peak pressure on the 1st MTPJ locality showed significant reduction of 37% and 29% with the use of SCF (p < 0.004) and PPF (p < 0.004), respectively.ConclusionsAll 4 commonly used insole materials were able to reduce pressure across the whole foot with PPF achieving significance. Off-loading the 1st MTPJ would still be best achieved with the commonly used plantar metatarsal pad of SCF with the aperture cut-out design.     

Risk Factors for Nonunion After First Metatarsophalangeal Joint Arthrodesis With a Dorsal Locking Plate and Compression Screw Construct: Correction of Hallux Valgus Is Key

First metatarsophalangeal joint (MTPJ) arthrodesis is currently the gold standard technique for advanced hallux rigidus. This retrospective study aimed to identify the risk factors for nonunion after first MTPJ arthrodesis with a dorsal locking plate and compression screw construct. Between April 2014 and April 2019, 165 consecutive patients (28 men and 137 women; mean age, 60 (range, 28-84) years) who underwent 178 primary first MTPJ arthrodeses were retrospectively reviewed. All arthrodeses were performed using either a dorsal locking plate with an integrated compression screw (Anchorage CP plate, Stryker, n = 97) or a dorsal locking plate (Anchorage V2 plate, Stryker, n = 81) with a separate compression screw (4 mm cannulated ACE screw). Union was defined as bone bridging across the fusion site on at least 2 of the 3 standard foot radiographs (anteroposterior, lateral, oblique) and no MTPJ movement or pain during clinical examination. Potential risk factors for nonunion were analyzed with the use of univariate and multivariate analyses. The overall nonunion rate was 6.2% (11 of 178 cases). The risk factors identified in the univariate analysis included preoperative hallux valgus deformity, postoperative residual hallux valgus deformity, and diabetes (p < .05). Multivariate analysis confirmed that postoperative residual hallux valgus deformity (odds ratio 6.5; p= .015) and diabetes (odds ratio 7.4; p = .019) are independent risk factors for nonunion after first MTPJ arthrodesis. Diabetes is the most important independent risk factor for nonunion after first MTPJ arthrodesis with a dorsal locking plate and compression screw construct. A residual postoperative hallux valgus deformity is associated with a significantly increased risk for nonunion. It is therefore crucial to correct the hallux valgus deformity to a hallux valgus angle of less than 20°.     

Minimally invasive distal first metatarsal osteotomy can be an option for recurrent hallux valgus

BackgroundRecurrence rate of surgical treatment of hallux valgus ranges in the literature from 2.7% to 16%, regardless of used procedure. In this study, long-term results of a minimally invasive distal osteotomy of the first metatarsal bone for treatment of recurrent hallux valgus are described.Methods32 consecutive percutaneous distal osteotomies of the first metatarsal were performed in 26 patients for treatment of recurrent hallux valgus. Primary surgery had been soft tissue procedures in 8 cases (25%), first metatarsal or phalangeal osteotomies in 19 cases (59.4%) and Keller procedures in 5 cases (15.6%).ResultsPatients were assessed with a mean follow-up of 9.8 ± 4.3 years. All patients reported the disappearance or reduction of the pain. The mean overall AOFAS score improved from 46.9 ± 17.8 points to 85.2 ± 14.9 at final follow-up. The mean hallux valgus angle decreased from 26.1 ± 9.1 to 9.7 ± 5.4°, the intermetatarsal angle decreased from 11.5 ± 4.5 to 6.7 ± 4.0°. No major complications were recorded with a re-recurrence rate of 3.1% (1 case).ConclusionsPercutaneous distal osteotomy of the first metatarsal can be a reliable and safe surgical option in the recurrent hallux valgus with low complication rate and the advantages of a minimally invasive surgery.Levels of evidence: IV, Retrospective Case Series.     

The progression of hallux valgus in the oriental Chinese population in Hong Kong

BackgroundHallux valgus is the lateral deviation of the great toe at the MTPJ that has many attributing aetiologies. This study will aim to identify whether hallux valgus progresses over time in the oriental Chinese population in Hong Kong.MethodsPatients with acquired symptomatic hallux valgus who presented to clinic between 2008 and 2013 were included. The deformities were analysed radiologically at presentation and pre-operative and angles were measured. These angles were analysed in relation to the waiting time from presentation to surgery.ResultsA sample of 43 cases from 38 patients (Mean age 63 years, range 48–80 years) were included. Forty-one cases had a hallux valgus angle (HVA) >24° at presentation (Mean 40.4°) and all had an intermetatarsal angle (IMA) >9°. A significant difference is seen with HVA (p = 0.040, t = −2.128) at presentation and pre-op but not IMA (p = 0.281, t = −1.095).The average wait for surgery was 705.7 days which had shown significant correlation with progression in HVA (p = 0.031). No significant difference was seen between IMA and waiting time to surgery (p = 0.195).DiscussionThe findings suggests severe hallux valgus deformity does progress over time in Hong Kong. Shorter waiting times for surgery could be beneficial to this population.Level III, retrospective comparative series.     

Scarf osteotomy for the treatment of moderate to severe hallux valgus: Analysis of predictors for midterm outcomes and recurrence

BackgroundControversies remain regarding the predictors for outcomes and recurrence after scarf osteotomy for hallux valgus deformity.MethodsSixty-two patients (70 feet) underwent scarf osteotomy for hallux valgus deformity. The radiological angles, tibial sesamoid position, articular congruence, demographics, comorbidities, AOFAS, VAS and SF-12 scores, and the postoperative compliance were tested as predictors for outcomes and recurrence.ResultsAfter a mean 38 ± 15.4 months follow-up, all of the radiological angles, the total AOFAS, PCS-12 and VAS scores significantly improved (all P < 0.001). Preoperative MCS-12 was directly related to the total postoperative AOFAS score (P = 0.003). A higher number of cardiovascular risk factors negatively affected the postoperative total AOFAS score, VAS and PCS-12 (β = −3.42, P = 0.030; β = 0.262, P = 0.022; β = −0.181, P = 0.025, respectively). The BMI influenced postoperative PCS-12 (β = −0.244, P = 0.002). Preoperative HVA was directly related to postoperative DMAA (P = 0.002) and tibial sesamoid position (P = 0.005). Preoperative joint incongruence and postoperative noncompliance were associated with recurrence (P = 0.043 and P = 0.035, respectively).ConclusionsSatisfactory results can be expected after scarf osteotomy. Higher BMI and number of cardiovascular risk factors, and low mental status should be carefully considered when counselling patients for this procedure. Adherence to postoperative care instructions influences deformity recurrence.     

Valenti resection arthroplasty for hallux rigidus: A systematic review

BackgroundValente Valenti proposed in 1976 a “V” resection of the first metatarsophalangeal joint (MPT1) on the sagittal plane for advanced stages of hallux limitus/rigidus, preserving length of the first ray, flexor hallux brevis and sesamoid function. The available literature concerning correct indications, management and clinical outcomes of the Valenti procedure (VP) and its modifications in patients affected by hallux limitus/rigidus was systematically analyzed.MethodsTitles and abstracts of all selected articles were independently screened by two authors to assess their suitability to the research focus.ResultsSelection produced 8 articles as full-text, for a total of 347 patients, with a mean follow-up of 6 ± 7.1 (range 0.2–17.5) years. Most common complication was transient sesamoiditis in 21 (7.4%) patients. No substantial differences in clinical outcomes were found between the original and modified techniques.ConclusionsVP appears to allow an early recovery with few complications, if compared to fusion, interposition arthroplasties or osteotomies. The wide joint resection does not prevent, if necessary, further procedures such as fusion or implants.Level of evidenceLevel I, systematic review.     

Biomechanical comparison of first metatarsophalangeal joint arthrodeses using triple-threaded headless screws versus partially threaded lag screws

BackgroundTriple-threaded, cannulated headless screws of varying thread diameters and pitch are designed to maintain thread length across the arthrodesis plane, provide joint compression, and reduce countersinking. This study tested the biomechanical fixation strength of conventional partially threaded lag screws compared to triple-threaded headless screws in first metatarsophalangeal joint arthrodesis.MethodsFirst metatarsophalangeal joint arthrodesis using a crossed screw technique was performed on 11 paired, preserved cadaver first rays with two 4.0-mm triple-threaded, cannulated headless screws or two 4.0-mm partially threaded, cannulated lag screws. The constructs were tested to failure through dorsally directed cantilever bending.ResultsThe triple-threaded, cannulated headless screws displayed significantly greater bending stiffness (p = 0.017) and failure load (p = 0.040) during load-to-failure testing compared to the partially threaded, cannulated lag screws.ConclusionsTriple-threaded, cannulated headless screws may be a viable alternative to partially threaded lag screws in first metatarsophalangeal arthrodesis.     

Modified Lapidus arthrodesis with plantar plate and compression screw for treatment of hallux valgus with hypermobility of the first ray: A preliminary report

BackgroundTMT-1 arthrodesis is an established method in hallux valgus surgery, but it is technically demanding and typically calls for a period of postoperative immobilization.MethodsIn this cohort study, initial experience with a plantar plate is described. 58 patients (59 arthrodesis) were included.ResultsThe mean duration of protected full weight bearing was 7 weeks. 94.12% patients were satisfied with the results, bony union was achieved in 98.31%. The Foot Function Index improved by 33 to a mean of 8 (p < .001). The postoperative Mayo Clinic Forefoot Score was excellent in 47.04 and good in 47.04%. The mean hallux valgus angle improved by 24.4–13.2° (p < .001). The mean first intermetatarsal angle improved by 11.2–5.2° (p < .001).ConclusionInitial experience with this form of fixation appears to provide suitable stability, allow early-protected weight bearing, with an acceptable level of complications.