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Engasser WM, Coetzee JC, Seybold JD, Dock CC, Seiffert KJ, Stone McGaver R, Attia AK, Den Hartog BD. Early Functional Outcomes and Complications of Tibial and/or Peroneal Sesamoidectomy Utilizing a Burr Through a Medial Approach. Foot Ankle Int 2024:10711007241264239. [PMID: 39075767 DOI: 10.1177/10711007241264239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
BACKGROUND Sesamoid pathology can lead to significant pain and disability both with activities of daily living and high-impact athletic movements. Sesamoidectomy is a widely used procedure for patients who fail conservative treatment measures. Traditional dorsal or plantar approaches for sesamoidectomy have shown to successfully alleviate pain, but complications were reported. A proposed alternative medial approach using a burr may provide many advantages compared with traditional approaches. This study presents patient outcomes and complications for this technique. METHODS This was a retrospective chart review of patients undergoing sesamoidectomy (tibial, peroneal, or both) using a burr through a medial approach to the sesamoid metatarsal articulation. Data collected included patient demographics, radiographic analysis, and outcomes: Veterans Rand 12 Item Health Survey (VR-12), Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS), patient satisfaction, and complications. RESULTS Twenty-seven patients (29 feet) were included. The mean age was 38.4 years followed up for a mean of 30.9 months. VR-12 physical component improved from 35.98 ± 7.86 to 51.34 ± 8.01 (P < .001), FAAM ADL and sport improved from 58.33 ± 16.61 to 83.27 ± 18.28 (P < .001) and 26.37 ± 20.31 to 63.75 ± 29.74 (P < .001), respectively. Patient satisfaction with the treatment was 80.59% ± 27.06%. The overall complication rate was 11 (37.9%) whereas the overall reoperation rate was 4 (13.7%) of 29 feet. Complications included 1 arthrofibrosis, 1 flexor hallucis longus subacute rupture, and 1 asymptomatic hallux valgus. There were no sesamoid excision revisions. CONCLUSION Sesamoidectomy using a medial approach with a burr provided significantly improved short-term functional outcomes, 80% patient satisfaction rate, with a relatively acceptable complications rate including 20% persistent pain. The medial approach is familiar to orthopaedic foot and ankle surgeons, provides adequate exposure, and eliminates the possibility of a painful plantar scar while avoiding disruption of the plantar plate, flexor hallucis brevis tendon, and ligamentous structures attached to the sesamoids. Larger studies with long-term follow-up from other centers are needed.
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Saxena A, Fournier M, Patel P, Maffulli N. Sesamoidectomy in Athletes: Outcomes From 2-Centers. J Foot Ankle Surg 2022; 61:139-142. [PMID: 34353730 DOI: 10.1053/j.jfas.2021.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 06/10/2021] [Accepted: 07/14/2021] [Indexed: 02/03/2023]
Abstract
Sesamoid pain can arise from avascular necrosis, fracture, osteochondrosis, and advanced degeneration. Disorders of the sesamoids in athletes can be debilitating. Total sesamoidectomy of the involved sesamoid is considered an effective surgical treatment when conservative measures have failed. There is limited literature evaluating the outcome of sesamoidectomy in athletically active patients. Our 2-center study reports on 68 patients (70 procedures; 2 male patients were operated on both feet in separate procedures approximately 3 years apart; 41 (58.6%) tibial and 29 (41.4%) fibular sesamoidectomies; 24 males and 44 females, average age 28.4 ± 12.2 years) who underwent total sesamoidectomy from 01/2001 to 12/2019. In our cohort, the average time to return to activity (RTA) was 11.1 ± 5.1 weeks, with no statistically significant difference between gender and age, or between fibular and tibial sesamoidectomy in relation to RTA. There was a minimum follow-up of 1 year, with an average of 106.6 ± 66.6 months. The total incidence of complication rate was 5.7%. In athletes in whom conservative management has failed, sesamoidectomy is safe, and allows predictable return to their chosen sport. To our knowledge, none of the patients subsequently developed pathology to the remaining sesamoid.
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Affiliation(s)
- Amol Saxena
- Fellowship Director, Sutter Health, Palo Alto, CA
| | | | - Parth Patel
- 3rd Year Podiatry Student, Western University College of Podiatric Medicine, Pomona, CA
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Fisciano, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, London, UK; Keele University Faculty of Medicine, School of Pharmacy and Bioengineering, Stoke on Trent, UK
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Nakajima K. Arthroscopic Sesamoidectomy for Hallux Sesamoid Disorders. J Foot Ankle Surg 2022; 61:175-180. [PMID: 34266722 DOI: 10.1053/j.jfas.2021.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 02/03/2023]
Abstract
In this retrospective case series, we aimed to study arthroscopic sesamoidectomy, including surgical methods, clinical outcomes, and complications. We retrospectively reviewed the medical records of patients with hallux sesamoid disorders who underwent arthroscopic sesamoidectomy from July 2015 to July 2017. The visual analog scale for rating pain, Japanese Society for Surgery of the Foot scale scores, number of days taken to return to normal daily living, number of months taken to return to playing sports, and complications were analyzed. The mean follow-up duration was 3.2 years. Among 14 patients, there were 8 females and 6 males (median age: 39 years). The mean visual analog scale score improved from 75.4 to 14.3 mm; the mean Japanese Society for Surgery of the Foot score improved from 55.2 to 88.0 points. The mean time to return to activities of daily living was 5.3 days. Among the 5 patients who played sports, 3 and 2 patients resumed playing sports at 3 and 12 postoperative months, respectively. Complications included wound pain (n = 4), discomfort in severe weather (n = 4), numbness (n = 3), pain in the sole other than in the ball of the foot (n = 2), pain during hallux dorsiflexion (n = 2), residual sesamoid discomfort (n = 1), swelling (n = 1), toe-in gait (n = 1), and metatarsal head bone marrow edema (n = 1). Despite good clinical outcomes of arthroscopic sesamoidectomy, patients should be made aware of the many potential complications of this procedure prior to surgery.
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Affiliation(s)
- Kenichiro Nakajima
- Department of Orthopedic Surgery, Yashio Central General Hospital, Saitama, Japan.
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Ford SE, Adair CR, Cohen BE, Davis WH, Ellington JK, Jones CP, Anderson RB. Efficacy, Outcomes, and Alignment Following Isolated Fibular Sesamoidectomy via a Plantar Approach. Foot Ankle Int 2019; 40:1375-1381. [PMID: 31434509 DOI: 10.1177/1071100719868734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate patients for intermediate-term pain relief, functional outcome, and changes in hallux alignment following isolated, complete fibular sesamoidectomy via a plantar approach for sesamoid-related pain recalcitrant to conservative treatment. METHODS A retrospective query of a tertiary referral center administrative database was performed using the Current Procedural Terminology code 28135 for sesamoidectomy between 2005 and 2016. Patients who underwent an isolated fibular sesamoidectomy were identified and contacted to return for an office visit. The primary outcome measure was change in visual analog pain score at final follow-up. Secondary measures included satisfaction, hallux flexion strength, hallux alignment, pedobarographic assessment, and postoperative functional outcome scores. Patients who met the 2-year clinical or radiographic follow-up minimum were included. Ninety fibular sesamoidectomies were identified. Thirty-six sesamoidectomies met inclusion criteria (median 60-month follow-up). The average patient was 36 years old and underwent sesamoidectomy 1.1 years after initial diagnosis. RESULTS Median visual analog scale scores improved 5 (6 to 1) points at final follow-up (P < .001). Final postoperative mean hallux valgus angle did not differ from preoperative values (10.5 degrees/8.5 degrees, P = .12); similarly, the intermetatarsal angle did not differ (8.0 degrees/7.9 degrees, P = .53). Eighty-eight percent of patients would have surgery again and 70% were "very satisfied" with their result. Hallux flexion strength (mean 14.7 pounds) did not differ relative to the contralateral foot (mean 16.1 pounds) (P = .23). Among the full 92 case cohort, 3 patients underwent 4 known reoperations. CONCLUSION Fibular sesamoidectomy effectively provided pain relief (median 5-year follow-up) for patients with sesamoid pathology without affecting hallux alignment. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Samuel E Ford
- OrthoCarolina Foot & Ankle Institute, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Christopher R Adair
- Orthopaedic Associates of Dallas, Baylor University Medical Center, Dallas, TX, USA
| | - Bruce E Cohen
- OrthoCarolina Foot & Ankle Institute, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - W Hodges Davis
- OrthoCarolina Foot & Ankle Institute, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - J Kent Ellington
- OrthoCarolina Foot & Ankle Institute, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Carroll P Jones
- OrthoCarolina Foot & Ankle Institute, Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
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Pearson JM, Moraes LVM, Paul KD, Peng J, Chinnakkannu K, McKissack HM, Shah A. Is Fibular Sesamoidectomy a Viable Option for Sesamoiditis? A Retrospective Study. Cureus 2019; 11:e4939. [PMID: 31431844 PMCID: PMC6695232 DOI: 10.7759/cureus.4939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Pathologic conditions of the sesamoids can be a source of disabling pain for patients, particularly during toe-off. Some underlying causes include osteonecrosis, inflammation, arthritis, and fracture. Nonoperative treatment is the initial standard of care, and has demonstrated satisfactory outcomes overall; however, operative management may be indicated in cases of pain refractory to conservative management. Sesamoidectomy is an uncommon procedure with risk of potential complications, but may be warranted in select cases of failed nonoperative treatment. Methods A retrospective chart review was conducted at one institution from 2009 to 2018. Twelve patients diagnosed with fibular sesamoiditis were treated with sesamoidectomy. Baseline patient demographics as well as postoperative outcomes were recorded. Results All 12 patients underwent fibular sesamoidectomy using the plantar approach following which their symptom (pain) resolved. Average follow-up for this cohort was 35 months. Of the sample, two patients experienced transient neuritis, one patient developed a superficial infection, and one had painful postoperative scarring. Hallux varus deformity was not observed in any patients. Conclusion Fibular sesamoidectomy may be a safe, viable procedure for patients with sesamoiditis who fail conservative measures.
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Affiliation(s)
- Jeffrey M Pearson
- Orthopaedic Surgery, University of Alabama School of Medicine, Birmingham, USA
| | - Leonardo V M Moraes
- Orthopedics, Instituto De Assistência Médica Ao Servidor Público Estadual (IAMPSE), São Paulo, BRA
| | - Kyle D Paul
- Orthopaedics, University of Alabama School of Medicine, Birmingham, USA
| | - Jianguang Peng
- Orthopaedic Surgery, Xuanwu Hospital Capital Medical University, Beijing, CHN
| | | | - Haley M McKissack
- Orthopaedics, University of Alabama School of Medicine, Birmingham, USA
| | - Ashish Shah
- Orthopaedics, University of Alabama School of Medicine, Birmingham, USA
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Shimozono Y, Hurley ET, Brown AJ, Kennedy JG. Sesamoidectomy for Hallux Sesamoid Disorders: A Systematic Review. J Foot Ankle Surg 2019; 57:1186-1190. [PMID: 30177453 DOI: 10.1053/j.jfas.2018.03.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Indexed: 02/07/2023]
Abstract
Studies have shown that sesamoidectomy provides good clinical outcomes; however, concern exists regarding complications occurring after resection of 1 or both sesamoid bones. The purpose of the present systematic review was to evaluate the current evidence on sesamoidectomy for the treatment of hallux sesamoid disorders. A systematic search of the MEDLINE, Embase, and Cochrane Library databases was performed during October 2017. The included studies were evaluated for the level of evidence and quality of evidence using the Coleman Methodology Score. Variable reporting outcomes data, clinical outcomes, and percentage of patients returning to sports at their previous level were evaluated. Ten studies, totaling 196 feet, were included. The weighted mean patient age was 36.6 ± 11.0 years, and the weighted mean follow-up duration was 45.1 ± 19.3 months. The mean visual analog scale score improved from 6.5 ± 0.3 to 1.2 ± 0.5. The mean postoperative American Orthopaedic Foot and Ankle Society ankle-hindfoot scale score was 92.7 ± 2.7. Six studies demonstrated that 94.4% of patients returned to sports, with 90.0% returning to their previous level, at a mean of 11.8 ± 1.8 weeks. The mean hallux valgus angle increased from 13.1° ± 2.1° preoperatively to 14.8° ± 3.7° postoperatively (p = .470), and the mean intermetatarsal angle increased from 8.7° ± 0.8° to 9.7° ± 0.8° (p = .180). Overall complication rate was 22.5% and the revision rate was 3.0%. The present systematic review has demonstrated that sesamoidectomy for hallux sesamoids disorders yields good clinical outcomes and a high rate of return to sports in the short term, albeit with a high complication rate of 22.5%.
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Affiliation(s)
- Yoshiharu Shimozono
- Orthopaedic Surgeon, Hospital for Special Surgery, New York, NY; Orthopaedic Surgeon, Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan; Orthopaedic Surgeon, Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Eoghan T Hurley
- Research Fellow, Hospital for Special Surgery, New York, NY; Research Fellow, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - John G Kennedy
- Orthopaedic Surgeon, Hospital for Special Surgery, New York, NY
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