SLR - December 2012 - Litherland
Reference: Yong Sang Kim, MD, et. al. Clinical Comparison of the Osteochondral Autograft Transfer System and Subchondral Drilling in Osteochondral Defects of the First Metatarsal Head. Am J Sports Med 2012 40:1824.
Scientific Literature Review
Reviewed by: Raquel Litherland, DPM
Residency Program: Botsford Hospital
Podiatric Relevance:
This article provides an alternative treatment for osteochondritis dissecans of the first metatarsal head, seen in the early stages of hallux rigidus.
Methods:
Between 2008 and 2010, authors retrospectively evaluated 24 cases of osteochondral defects of the first metatarsal head treated operatively. Two different surgical procedures were elected after the osteochondral defect was identified with MRI: 14 patients underwent subchondral drilling (group A) and 10 patients underwent osteochondral autograft transfer system (OATS) (group B). The average age of the patients was 38.9 years. There were eight men and 14 women. The mean follow-up for all patients was 25.1 months. All patients went through a minimum of three months failed conservative treatment prior to surgical intervention. For clinical evaluation, two systems were used: the visual analog scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal scale. To assess the improvement in sports activity, the Tegner activity scale was utilized.
Results:
Clinically, for the last follow-up VAS score, the defect size accounted for 93.7 percent of the variability in group A and 12.7 percent in group B. For the last AOFAS score, the defect size accounted for 93.5 percent of the variability in group A and 0.7 percent in group B. Patients with a defect size larger than 50 square mm was a significant predictor of poor clinical outcomes in group A. There was no association of defect size with negative clinical outcomes in group B. There was no association found between location of the defect and clinical outcome in either group. Regarding sports activity, return to activity was an average of 16.4 weeks group A and 15.9 weeks in group B with the most improvement with jogging and mountain climbing in group B.
Conclusions:
Limitations of this study were small number of cases (24) and short duration of the follow-up period (mean follow-up 25.1 weeks). The outcomes of the study suggest for osteochondral defects larger than 50 square mm or when subchondral cyst exists, the OATS procedure could potentially be used as a treatment of choice for osteochondral defects of the first metatarsal head to restore functionality of the metatarsophalangeal joint.