SLR - June 2012 - Kelly Bumpus
Reference: Ahn JH, Choy WS, Lee KW. Arthroscopy of the First Metatarsophalangeal Joint in 59 Consecutive Cases. Journal of Foot Ankle Surgery. 2012 Mar-Apr;51(2):161-7
Scientific Literature Review
Reviewed by: Kelly Bumpus, DPM
Residency Program: Cleveland Clinic Foundation/Kaiser Permanente
Podiatric Relevance:
Arthroscopic procedures for small joints are being performed more regularly. The advantages include minimal damage to the periarticular tissues, shortened postoperative recovery time, and decreased joint stiffness.
Methods:
The study design consisted of 59 patients, totaling 69 first MTP joint arthroscopic procedures between July 2003 and December 2008, who were followed radiographically using an AOFAS hallux MP-IP scale for a minimum of 18 months. Procedures included 36 lateral releases, 17 synovectomies, six arthrolyses, three cheilectomies, three medial sesamoid excisions, two curettages and drillings, and two joint debridements. The most common indication was hallux valgus. Other indications included arthrofibrosis, hallux rigidus, gouty arthritis, nonunion of sesamoid fracture, septic arthritis and osteochondral lesion. Arthroscopy was offered when the patients failed to respond to non-operative treatment, unless contraindicated by sepsis. A total of 14 (23.73 percent) male and 45 (76.27 percent) female patients were included. Age ranged from 16 to 69 (mean 45.3) years.
Results:
Mean AOFAS hallux MP scale scores were increased from 69 points preoperatively to 92 points postoperatively. The statistical significance of AOFAS scores for each disorder was not found primarily because of the small number of patients except in cases of hallux valgus. Radiographically, the overall mean hallux abductus angle improved from 29.2 to 9.7 degrees. The mean first intermetatarsal angle improved from 14.8 to 7.7. All cases showed an improvement of the medial sesamoid position postoperatively. There were no recurrences of deformity, hallux varus or postoperative stiffness observed. There were two reported complications: a superficial wound infection and a transient neurapraxia of the dorsolateral digital nerve. Overall, 94.92 percent (56 of 59) of patients who underwent therapeutic arthroscopy were satisfied with the procedures.
Conclusions:
The authors were able to perform lateral release with open distal or proximal metatarsal osteotomies for mild to moderate hallux valgus, with adequate correction and maintenance of function. Radiographic angles were significantly improved. Although not statistically significant, satisfactory results were obtained for previously mentioned procedures as well, reinforcing findings of other studies on first ray arthroscopy. Adequate patient selection is essential and these results should be further reinforced with prospective randomized studies.