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Hull M, Campbell JT, Jeng CL, Henn RF, Cerrato RA. Measuring Visualized Joint Surface in Hallux Metatarsophalangeal Arthroscopy. Foot Ankle Int 2018; 39:978-983. [PMID: 29661083 DOI: 10.1177/1071100718770365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthroscopy has been increasingly used to evaluate small joints in the foot and ankle. In the hallux metatarsophalangeal (MTP) joint, little data exist evaluating the efficacy of arthroscopy to visualize the articular surface. The goal of this cadaveric study was to determine how much articular surface of the MTP joint could be visualized during joint arthroscopy. METHODS Ten fresh cadaveric foot specimens were evaluated using standard arthroscopy techniques. The edges of the visualized joint surface were marked with curettes and Kirschner wires; the joints were then surgically exposed and imaged. The visualized surface area was measured using ImageJ® software. RESULTS On the distal 2-dimensional projection of the joint surface, an average 57.5% (range, 49.6%-65.3%) of the metatarsal head and 100% (range, 100%-100%) of the proximal phalanx base were visualized. From a lateral view of the metatarsal head, an average 72 degrees (range, 65-80 degrees) was visualized out of an average total articular arc of 199 degrees (range, 192-206 degrees), for an average 36.5% (range, 32.2%-40.8%) of the articular arc. CONCLUSION Complete visualization of the proximal phalanx base was obtained. Incomplete metatarsal head visualization was obtained, but this is limited by technique limitations that may not reflect clinical practice. CLINICAL RELEVANCE This information helps to validate the utility of arthrosocpy at the hallux metatarsophalangeal joint.
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Affiliation(s)
| | - John T Campbell
- 2 Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
| | - Clifford L Jeng
- 2 Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
| | - R Frank Henn
- 3 Department of Orthopaedic Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Rebecca A Cerrato
- 2 Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
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Simplified Setup to Achieve Distraction for Toe Arthroscopy. Arthrosc Tech 2016; 5:e815-e819. [PMID: 27709042 PMCID: PMC5040197 DOI: 10.1016/j.eats.2016.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 03/30/2016] [Indexed: 02/03/2023] Open
Abstract
Toe arthroscopy has historically had limited applications but is beginning to emerge as a viable treatment option for select toe pathologies, and continues to have expanding indications as technology and techniques improve. Toe arthroscopy has used a multitude of distraction techniques to perform the procedures but all have had limited success. Thus, we propose a simple toe arthroscopy distraction technique that uses an external positioning arm to allow the surgeon to apply manual traction in multiple positions without the use of an assistant, external weights, or any reprocessed sterile equipment.
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Abstract
A turf toe injury encompasses a wide spectrum of traumatic problems that occur to the first metatarsophalangeal joint. Most of these injuries are mild and respond well to nonoperative management. However, more severe injuries may require surgical management, including presence of diastasis or retraction of sesamoids, vertical instability, traumatic hallux valgus deformity, chondral injury, loose body, and failed conservative treatment.
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Affiliation(s)
- Lyndon W Mason
- Foot and Ankle Unit, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK.
| | - Andrew P Molloy
- Foot and Ankle Unit, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK
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Lui TH. First metatarsophalangeal arthroscopy in patients with post-traumatic hallux valgus. Foot (Edinb) 2015; 25:270-6. [PMID: 26362238 DOI: 10.1016/j.foot.2015.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 06/21/2015] [Accepted: 07/31/2015] [Indexed: 02/04/2023]
Abstract
Post-traumatic hallux valgus is relatively rare and has been reported after rupture of the medial collateral ligament of the first metatarsophalangeal (MTP-1) joint; Lisfranc joint injury; turf toe injury; medial plantar nerve entrapment secondary to tibial fracture or first metatarsal fracture. Post-traumatic hallux valgus after medial collateral ligament injury has a high incidence of MTP-1 pathology. Detailed history and clinical examination can facilitate differentiation of the source(s) of the patient's symptoms and assist accurate formulation of the surgical plan. First, MTP arthroscopy is a feasible diagnostic and therapeutic tool to manage the MTP-1 joint pain in hallux valgus following injury to the MTP-1 joint.
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Affiliation(s)
- T H Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong SAR, China.
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Abstract
Arthroscopic treatment of hallux rigidus is appropriate after failed nonoperative treatment. Debridement with cheilectomy, and fusion are the main indications for arthroscopic treatment of hallux rigidus. If the cartilage damage is extensive and the patient has consented, then a fusion is performed at the same sitting.
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Affiliation(s)
- Timo Schmid
- University of British Columbia, 139 Drake Street, Vancouver, BC V6Z 2T8, Canada
| | - Alastair Younger
- Department of Orthopaedics, University of British Columbia, 560 1144 Burrard Street, Vancouver, British Columbia V6Z 2A5, Canada.
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Kawchuk GN, Fryer J, Jaremko JL, Zeng H, Rowe L, Thompson R. Real-time visualization of joint cavitation. PLoS One 2015; 10:e0119470. [PMID: 25875374 PMCID: PMC4398549 DOI: 10.1371/journal.pone.0119470] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 01/23/2015] [Indexed: 11/18/2022] Open
Abstract
Cracking sounds emitted from human synovial joints have been attributed historically to the sudden collapse of a cavitation bubble formed as articular surfaces are separated. Unfortunately, bubble collapse as the source of joint cracking is inconsistent with many physical phenomena that define the joint cracking phenomenon. Here we present direct evidence from real-time magnetic resonance imaging that the mechanism of joint cracking is related to cavity formation rather than bubble collapse. In this study, ten metacarpophalangeal joints were studied by inserting the finger of interest into a flexible tube tightened around a length of cable used to provide long-axis traction. Before and after traction, static 3D T1-weighted magnetic resonance images were acquired. During traction, rapid cine magnetic resonance images were obtained from the joint midline at a rate of 3.2 frames per second until the cracking event occurred. As traction forces increased, real-time cine magnetic resonance imaging demonstrated rapid cavity inception at the time of joint separation and sound production after which the resulting cavity remained visible. Our results offer direct experimental evidence that joint cracking is associated with cavity inception rather than collapse of a pre-existing bubble. These observations are consistent with tribonucleation, a known process where opposing surfaces resist separation until a critical point where they then separate rapidly creating sustained gas cavities. Observed previously in vitro, this is the first in-vivo macroscopic demonstration of tribonucleation and as such, provides a new theoretical framework to investigate health outcomes associated with joint cracking.
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Affiliation(s)
- Gregory N Kawchuk
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jerome Fryer
- Private Practice, Nanaimo, British Columbia, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Hongbo Zeng
- Department of Chemical and Materials Engineering, Faculty of Engineering, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsay Rowe
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Richard Thompson
- Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Abstract
UNLABELLED Arthroscopy of the hallux metatarsophalangeal (MTP) joint is an evolving technique for hallux rigidus and other disorders of the hallux MTP joint. Purported advantages of this minimally invasive procedure include rapid rehabilitation and the ability to identify and address other intra-articular and sesamoid pathologies without additional dissection. Larger, prospective, and comparative outcomes studies are needed to optimize the treatment algorithm. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Kenneth J Hunt
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, USA
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Ahn JH, Choy WS, Lee KW. Arthroscopy of the first metatarsophalangeal joint in 59 consecutive cases. J Foot Ankle Surg 2011; 51:161-7. [PMID: 22197285 DOI: 10.1053/j.jfas.2011.10.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Indexed: 02/03/2023]
Abstract
The authors analyzed the results of 59 consecutive cases of the first metatarsophalangeal (MTP-I) joint arthroscopy to verify the efficacy and safety of the procedure. Fifty-nine patients were followed for >18 months after MTP-I joint arthroscopic procedures. The mean duration of follow-up was 25 months. Clinically, the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale and the satisfaction of the patients were evaluated. Hallux valgus angle, the first intermetatarsal angle, and medial sesamoid position were analyzed in cases of hallux valgus. The American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal scale score was increased from 69 points preoperatively to 92 points postoperatively (p < .05). Radiologically, the mean hallux valgus angle was decreased from 29.2° preoperatively to 9.7° postoperatively (p < .05). The mean first intermetatarsal angle was decreased from 14.8° preoperatively to 7.7° postoperatively (p < .05). The medial sesamoid position was improved from 4.8 preoperatively to 2.0 postoperatively (p < .05). Ninety-five percent of the patients were satisfied with the procedures. There was 1 case of a wound problem and 1 case of temporary digital nerve injury as complications. Based on our experience, arthroscopy of MTP-I joint appears to be a safe and reproducible procedure for selected cases of MTP-I joint disorders.
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Affiliation(s)
- Jae Hoon Ahn
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Kadakia AR, Molloy A. Current concepts review: traumatic disorders of the first metatarsophalangeal joint and sesamoid complex. Foot Ankle Int 2011; 32:834-9. [PMID: 22049873 DOI: 10.3113/fai.2011.0834] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Anish R Kadakia
- University of Michigan, Orthopaedic Surgery, 2098 South Main Street, Ann Arbor, MI 48103, USA.
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Bojanić I, Smoljanović T, Kubat O. Osteochondritis dissecans of the first metatarsophalangeal joint: arthroscopy and microfracture technique. J Foot Ankle Surg 2011; 50:623-5. [PMID: 21636292 DOI: 10.1053/j.jfas.2011.04.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Indexed: 02/03/2023]
Abstract
Osteochondritis dissecans (OCD) is a localized disorder of the joint surface by which a segment of subchondral bone and its overlying cartilage become fragmented. Arthroscopic treatment of OCD of the first metatarsophalangeal joint consisted mainly of debridement and loose body removal. The microfracture technique for the treatment of OCD of the first metatarsophalangeal joint is presented for the first time. The technique has been shown to be a safe and technically uncomplicated first-line treatment.
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Affiliation(s)
- Ivan Bojanić
- Department of Orthopaedic Surgery, Zagreb University School of Medicine, Zagreb, Croatia
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Galli MM, Hyer CF. Hallux rigidus: what lies beyond fusion, resectional arthroplasty, and implants. Clin Podiatr Med Surg 2011; 28:385-403, ix. [PMID: 21669345 DOI: 10.1016/j.cpm.2011.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hallux rigidus (HR) is the limitation of motion at the first metatarsophalangeal (MTP) joint, most commonly secondary to degenerative arthritis. Surgical options for treating HR include 2 general categories: joint salvage and joint destruction. A hybrid of techniques from the 2 categories has emerged: cartilage resurfacing, interpositional arthroplasty, and arthrodiastasis. These procedures address the pathologic condition of the first MTP joint more directly than joint salvage and avoid many of the negative complications, consequences, and connotations of joint destruction procedures. Alternative surgical options for the treatment of recalcitrant pain associated with HR are evolving and are discussed in this review.
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Affiliation(s)
- Melissa M Galli
- Department of Orthopaedics, The Ohio State University Medical Center, 410 West 10th Avenue, N-1050, Columbus, OH 43210, USA
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Ahearne D, Rosenfeld P. Surgical approaches to the forefoot for common sports-related pathologies: a review of the literature and cadaveric dissection. Knee Surg Sports Traumatol Arthrosc 2010; 18:587-93. [PMID: 20217389 DOI: 10.1007/s00167-010-1096-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 02/16/2010] [Indexed: 11/30/2022]
Abstract
This article reviews the published literature regarding the surgical approaches to pathologies encountered within the forefoot, including arthroscopic and open techniques, and their treatment. We have demonstrated these surgical approaches with cadavers, to identify the key anatomical landmarks and safe zones for these surgical techniques, to prevent the complications associated with their treatment.
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Abstract
Arthroscopy of the first MTP joint is a useful, minimally invasive technique in treating a number of pathologies about the hallux MTP joint. However, it is a technically demanding procedure for which there is a learning curve. The small arthroscope and instrumentation are delicate and vulnerable to damage. Practice on cadavers is very useful in shortening this learning curve, and experience with arthroscopy in other joints facilitates the transition to the hallux. In the future, additional studies will help to more specifically define the indications and expected outcomes of treatment as such will help to further elucidate the potential benefits over open surgery.
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Affiliation(s)
- Dominic S Carreira
- Broward Health Orthopedics, 300 SE 17th St, First Floor, Fort Lauderdale, FL 33316, USA.
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Arthroscopic elimination of monosodium urate deposition of the first metatarsophalangeal joint reduces the recurrence of gout. Arthroscopy 2009; 25:153-8. [PMID: 19171274 DOI: 10.1016/j.arthro.2008.09.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 09/01/2008] [Accepted: 09/03/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if the arthroscopic removal of gouty crystal deposits from the first metatarsophalangeal (MTP) joint will reduce the recurrence rate and improve foot function compared to medical treatment alone. METHODS Twenty-eight male patients with hyperuricemia (>7.0 mg/dL) and repeated attacks of gouty arthritis of the first MTP joint were included in this study. Arthroscopic intervention of the first MTP joint was performed on 15 patients (group 1), while the other 13 patients were treated with medication alone (group 2). The follow-up period (mean +/- standard deviation) was 3.9 +/- 1.1 years in group 1 and 2.4 +/- 0.3 years in group 2. RESULTS After treatment, both groups showed a significant improvement in the number of acute attacks of gouty arthritis and in their functional scores on the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale. On both measures, the results for group 1 were significantly better than those for group 2. CONCLUSIONS Arthroscopic removal of gouty crystals from the first MTP joint can reduce the rate of acute repeated attacks of gouty arthritis and increase foot and ankle function.
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Debnath UK, Hemmady MV, Hariharan K. Indications for and technique of first metatarsophalangeal joint arthroscopy. Foot Ankle Int 2006; 27:1049-54. [PMID: 17207431 DOI: 10.1177/107110070602701209] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthroscopy of the great toe metatarsophalangeal joint has been used for a variety of indications, ranging from synovitis to osteochondral defects. The purpose of the present study was to define the indications for arthroscopy, assess its efficacy, and demonstrate the limitations of this procedure. METHODS Hallux metatarsophalangeal joint arthroscopy was used in 20 patients (25 feet). Indications included degenerative disease with early osteophytosis, chondromalacia, osteochondral defects, loose bodies, arthrofibrosis, synovitis, gouty arthritis, first metatarsophalangeal joint pain with no obvious findings clinically and radiographically in young adults, and intra-articular fracture of the first metatarsophalangeal joint. All patients had a minimal followup of 2 years and were evaluated clinically and radiographically. RESULTS Arthroscopic surgery resulted in pain free first metatarsophalangeal joints in 95% (19 of 20 patients). Patients with degenerative disease had a pain-free joint for a minimum of 2 years. The patients with gouty arthritis and intra-articular fracture had good functional outcomes. Arthroscopy also helped in identifying the pathology in painful joints with no obvious radiographic features that included conditions such as 'meniscoid' and other impingement lesions. CONCLUSION Arthroscopy of the first metatarsophalangeal joint is not suitable for patients with extensive degenerative changes and large osteophytes and those that require cheilectomy or arthrodesis. Arthroscopic management of certain painful hallucal metatarsophalangeal joints is a specialized technique, which if performed for the right indications, gives a favorable outcome with minimal complications.
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Abstract
The development of arthroscopic techniques began in the early 1900s. Today, there are several techniques available for treating athletic injuries of the foot and ankle. This article describes arthroscopic techniques for the great toe, subtalar arthroscopy, anterior ankle impingement exostoses (footballer's ankle), posterior ankle arthroscopy, endoscopic calcaneoplasty, and osteochondral lesions of the talus. New techniques for arthroscopic repair of chronic ankle instability are reviewed, and the authors present their results with thermal-assisted capsular modification for chronic lateral ankle instability.
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Affiliation(s)
- Terrence M Philbin
- Department of Orthopaedic Surgery, The Ohio State University, Columbus, OH 43210, USA
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