Safety and Efficacy of Medial Plate in First Metatarsophalangeal Joint Arthrodesis

2021 ◽  
Vol 23 (3) ◽  
pp. 205-212
Author(s):  
Leszek Kuik ◽  
Piotr Łuczkiewicz
Keyword(s):  
Soft Tissues ◽  
Metatarsophalangeal Joint ◽  
Clinical Results ◽  
Dorsal Plate ◽  
Pain Level ◽  
Compression Screw ◽  
First Metatarsophalangeal Joint ◽  
Safety And Efficacy ◽  
The Mean ◽  
One Year

Background. Arthrodesis of the first metatarsophalangeal joint (MTP-1) is a recognized and effective procedure in advanced osteoarthritis of this joint. Fixation with a dorsal plate and a compression screw has been described as the most stable. Nevertheless, the frequency of revision procedures after MTP-1 arthrodesis has been reported to exceed 10% in some reports. The need for revision surgery is mostly related to the fixation material used and concern both its destabilization and a conflict between the implants and soft tissues. Therefore, there is still scope for developing new stabilization methods for the MTP-1 joint. Materials and methods. With the approval of the relevant Bioethics Committee, we conducted a pilot clinical trial to assess the safety and efficacy of the use of the medial plate in MTP-1 fusion. Twenty patients qualified for treatment due to osteoarthritis of the metatarsophalangeal joint were evaluated. The clinical results of the surgical treatment were assessed at least one year after the surgery. Results. The mean AOFAS MTP-IP score increased from 35.29±18.76 to 75.59±12.15. The mean EFAS score in­creased from 9.24±5.73 to 18.35±5.66. Pain level as per a VAS decreased from 6.24±1.48 to 1.59±2.58. A total of 18 patients were satisfied with the procedure, with the remaining 2 patients reporting the result as unsatisfactory. Two revision procedures were performed, both due to migration of the fixation material. Conclusions. 1. The clinical results of MTP-1 arthrodesis with the medial plate are comparable to the results in the litera­ture. 2. It can be concluded that the use of the medial plate in arthrodesis of the MTP-1 joint is safe and effective, and is a va­­luable alternative to existing methods.

Outcomes of First Metatarsophalangeal Joint Fusion Using a Precontoured Plate

2021 ◽  
pp. 193864002110005
Author(s):  
Michael Riediger ◽  
Gerard A. Sheridan ◽  
Rehan Gul
Keyword(s):  
Hallux Valgus ◽  
Short Form ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
Dorsal Plate ◽  
Foot And Ankle ◽  
First Metatarsophalangeal Joint ◽  
Hallux Valgus Deformity ◽  
Patient Reported ◽  
The Mean

Background: The purpose of this study was to determine the results of an arthrodesis technique of the first metatarsophalangeal joint (MTPJ) using a precontoured dorsal plate to correct the hallux valgus deformity. Methods: This was a retrospective analysis of outcomes for first MTPJ arthrodesis performed using 2 precontoured dorsal plates. Radiographic outcomes (intermetatarsal angle [IMA] and hallux valgus angle [HVA]) and patient-reported functional outcome measures (Short-Form 12 and Foot and Ankle Outcome Score) were recorded and compared. Results: Fifty-five patients underwent 77 first MTPJ arthrodeses for severe hallux valgus deformity with associated degenerative changes at the first MTPJ. The mean reduction of the IMA was 5.67° ( P < .05) and the mean reduction of the HVA was 33° ( P < .05). The Short-Form 12 assessment of global health demonstrated a significant improvement in both the physical and mental health composite scores by 16.4 points and 10.4 points ( P < .05), respectively. The Foot and Ankle Outcome Score demonstrated a cumulative decrease of 35% (59.28; P < .05) in all domains. Conclusions: First MTPJ arthrodesis using a precontoured dorsal plate is a successful procedure with a high union rate, low complication rate, and a high level of patient-reported satisfaction. Levels of Evidence: Level III.

scholarly journals First Metatarsophalangeal Joint Arthrodesis

2018 ◽  
Vol 3 (3) ◽  
pp. 247301141775267 ◽  
Author(s):  
Paola Filomeno ◽  
Julio López
Keyword(s):  
Patient Satisfaction ◽  
Plate Fixation ◽  
Metatarsophalangeal Joint ◽  
Functional Improvement ◽  
Dorsal Plate ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Joint Fusion ◽  
Vas Scores ◽  
Satisfaction Rates

Background: First metatarsophalangeal (MTP) joint arthrodesis can be fixed using either a dorsal plate or crossed screws. However, there is considerable difference in the cost of these implants, and it is not known if there is sufficient difference in outcome that might justify this cost difference. Our aim was to compare the functional results and patient satisfaction rates after first MTP joint arthrodesis in a group of patients using the same surgical technique except for the fixation devices. Methods: A prospective cohort of 27 patients who underwent first MTP joint fusion by the same surgeon using 2 crossed screws or a single screw with a dorsal plate was recruited over a 3-year period. Demographic information, patient satisfaction rates, complications, and union rates were evaluated. American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) scoring systems were used pre- and postoperatively to compare the functional outcomes. Thirty consecutive procedures (screws, n = 15; plate, n = 15) were performed. Age (55.8 ± 11.1 vs 63.3 ± 12.4 years for screws and plate respectively; P = .091) and female gender percentages (80% and 73%, P = .666) were similar between groups. Results: The overall union rate was 93% with no differences between groups. AOFAS and VAS scores improved significantly postoperatively for each technique, and no differences were found between the two in the improvement in AOFAS (42.4 ± 8.0 vs 44.3 ± 8.2, screws and plate respectively; P = .520) and VAS scores (66.0 ± 5.4 vs 69.0 ± 6.9; P = .195). The implant cost for screws was $40 and for dorsal plate, $328. Conclusions: First MTP joint fusion using either screws or plate fixation results in an improvement in AOFAS and VAS scores. Functional improvement and patient satisfaction did not differ between the 2 techniques, despite a considerable difference in cost between the two methods of fixation. Level of Evidence: Level III, prospective comparative study.

scholarly journals Treatment of hallux rigidus with percutaneous arthrodesis

2018 ◽  
Vol 12 (2) ◽  
pp. 90-95
Author(s):  
Vitor Baltazar Nogueira ◽  
Miguel Viana Pereira Filho ◽  
Mauro Cesar Mattos e Dinato ◽  
Márcio De Faria Freitas ◽  
Rodrigo Gonçalves Pagnano
Keyword(s):  
Medical Records ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Conventional Technique ◽  
Hallux Rigidus ◽  
Time Level ◽  
First Metatarsophalangeal Joint ◽  
The Mean ◽  
Pain Improvement ◽  
Consolidation Time

Objective: The objective of this study was to describe the percutaneous arthrodesis technique with single medial portal of the first metatarsophalangeal joint and to evaluate the results of a series of nine cases (10 feet) with a diagnosis of hallux rigidus subjected to this technique, comparing the results with literature data regarding the conventional technique. Methods: This was a retrospective, observational study performed by analysis of medical records and radiographs of nine patients undergoing percutaneous arthrodesis of the hallux metatarsophalangeal joint. Gender, age, consolidation time, level of postoperative pain and degree of patient satisfaction were evaluated. Results: Eight patients were female, and one patient was male. The mean age was 68.7 years, the mean consolidation time was 8 weeks, the consolidation ratio was 70%, there was pain improvement in the postoperative period, and all patients considered themselves satisfied with the surgery. Conclusion: Percutaneous arthrodesis of the metatarsophalangeal hallux joint potentially yields results similar to those of the conventional method demonstrated in the literature but uses smaller incisions.Level of Evidence IV, Therapeutic Studies, Case Series.

scholarly journals One-Year Visual and Refractive Outcomes following LASIK for Myopia and Myopic Astigmatism with MEL 90 versus Schwind Amaris 750S Excimer Laser: A Comparative Study

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Sheetal Brar ◽  
Dishitha P. Rathod ◽  
C. R. Roopashree ◽  
Sri Ganesh
Keyword(s):  
Comparative Study ◽  
Clinical Outcomes ◽  
Excimer Laser ◽  
Infectious Keratitis ◽  
Safety And Efficacy ◽  
Refractive Outcomes ◽  
The Mean ◽  
One Year ◽  
Myopic Astigmatism

Purpose. To compare clinical outcomes following LASIK for myopia performed with MEL 90 vs. Schwind Amaris 750S excimer laser. Methods. Data were collected retrospectively for patients who underwent Femto-LASIK, using the MEL 90 and Schwind Amaris 750S excimer laser for correction of myopia and myopic astigmatism within the range of −1.00 to −10.00 D SE from January 2013 till June 2018. Outcomes were analysed at 12 months for safety, efficacy, enhancement rate, and long-term complications. Results. A total of 328 eyes of 328 patients were analysed. One hundred and sixty-three eyes were treated with Schwind Amaris and the remaining 165 eyes with the MEL 90 laser. Twelve months postoperatively, the mean UDVA, CDVA, residual SE, and cylinder in the Amaris group were −0.10 ± 0.09 logMAR, −0.14 ± 0.06 logMAR, −0.21 ± 0.22 D, −0.13 ± 0.18 D versus −0.05 ± 0.07 logMAR, −0.09 ± 0.08 logMAR, −0.23 ± 0.23 D, and −0.14 ± 0.21 D for the MEL 90 group ( p values >0.05). For the Amaris group, safety and efficacy indices were 1.12 and 1.02, whereas for the MEL 90 group, these indices were 1.08 and 1.00, respectively. No eye in either group had any postop flap-related complications, infectious keratitis, diffuse lamellar keratitis, or keratectasia. Two eyes in the Amaris and 4 eyes in MEL 90 group required enhancement for the progression of myopia. Conclusion. At 12 months, both Schwind Amaris 750S and MEL 90 lasers demonstrated comparable clinical outcomes for myopic LASIK in a single surgeon setting.

scholarly journals Meniscus Repair Outcomes with and without Bone Marrow Aspiration Concentrate

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0028 ◽  
Author(s):  
Patrick Allan Massey ◽  
Andrew Zhang ◽  
Christine Bayt Stairs ◽  
Stephen Hoge ◽  
Trevor Carroll ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Bone Marrow Aspiration ◽  
Meniscus Repair ◽  
Control Group ◽  
Pain Level ◽  
Average Pain ◽  
The Mean ◽  
One Year ◽  
The One

Objectives: The purpose of the current study is to review the results of meniscus repairs with and without bone marrow aspiration concentrate (BMAC). It is hypothesized that with BMAC, meniscus repair outcomes will be improved when compared to without BMAC at 1 year after surgery. Methods: This is a prospective case control study performed from August 2014 until August 2017. Patients were included if they had a meniscus repair performed with no history of prior meniscus surgery to the operative knee. Patients were excluded if there was a full thickness cartilage tear or International Cartilage Repair Society (ICRS) Grade IV cartilage tear not treated in a single staged surgery. Patients were also excluded if they did not reach the one year follow-up, had a multi-ligamentous knee injury requiring multiple staged procedures. From August 2014 until November 2015, patients had meniscus repair without BMA. Menisci were all repaired arthroscopically using inside-out, outside-in and all-inside techniques. After November 2015, all meniscus repairs were augmented with BMAC. In the BMAC group, all bone marrow was obtained from the ipsilateral femur during the time of surgery. The Biocue BMAC system (Zimmer Biomet, Warsaw Indiana) was used for bone marrow aspiration and BMAC was injected directly into the tear site after repair. Numerical data such as VAS, lysholm and IKDC was analyzed using a 2 sample T-test. Categorical data such as sex, tear location, type of tear and zone of tear were analyzed using a chi-square. Results: A total of 150 patients were initially included in the study. The average age in the control group was 26.3 versus 29.4 in the BMAC group (P=0.27). Thirty seven percent of the control group had an ACL reconstruction versus 40% in the BMAC group (P= .77). The control group improved from an average pain level of 6.1 to 1.2 and the BMAC group improved from an average pain level of 5.9 to 0.7 at the 1 year end point. Both the control group and BMAC group improved with respect to pain with no difference at the 1 year end point (P=.19). There was, however a significantly larger reduction in pain at the 6 week and 3 month time point with BMAC compared to the control group (P=.02 and P=.02 respectively). At the 1-year follow-up, the mean lysholm score improved from 43 to 92 in the control group and 43 to 90 in the BMAC group. The mean IKDC score improved from 37 to 87 in the control group and 36 to 83 in the BMAC group at the one year follow-up. Conclusion: Meniscus repair outcomes were improved at 6 weeks and 3 months post-operatively, when BMAC is used to augment meniscus repair compared to repair without BMAC. Both groups, control group and BMAC meniscus repair group had improved outcomes at 1 year post-operatively with respect to VAS, lysholm and IKDC, with no difference in complication rate.

scholarly journals Arthroscopic Management for the Unstable Inferior Leaf of the Lateral Meniscus Anterior Horn and Associated Cysts through a Direct Inframeniscal Portal: A Retrospective Study

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Dongyang Chen ◽  
Qiangqiang Li ◽  
Ye Sun ◽  
Jianghui Qin ◽  
Yao Yao ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Full Range ◽  
Lateral Meniscus ◽  
Clinical Results ◽  
Anterior Horn ◽  
Arthroscopic Management ◽  
The Mean ◽  
Magnetic Resonance Scanning ◽  
One Year

Introduction. To investigate the clinical results of arthroscopic management for the unstable inferior leaf of the lateral meniscus anterior horn and associated cysts through an inframeniscal portal. Methods. From March 2005 to October 2014, 64 patients with an unstable inferior leaf of the lateral meniscus anterior horn and associated cysts underwent arthroscopic management with an inframeniscal portal. The mean age of the patients was 36.9 years (range, 18 to 49 years). The mean follow-up period was 28 months (range, 24 to 44 months). Clinical results were assessed using physical examination, the Lysholm knee score, and postoperative magnetic resonance scanning. Results. The median Lysholm score improved significantly at 1 year after surgery and at final follow-up. Magnetic resonance scanning at least one year after the operation revealed no recurrent meniscal tears or cysts. No reoperations were required after an average follow-up of 28 months. All patients reported significant symptomatic relief after the operation. They had full range of motion at three months and returned to normal activities and sports one year after surgery. Conclusion. The direct inframeniscal portal can provide an effective approach to manage lesions in the anterior horn of the lateral meniscus with predictable clinical outcomes.

scholarly journals Joint Preservation of the 1st MTP

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Bryan Van Dyke ◽  
Gregory Berlet ◽  
Justin Daigre ◽  
Christopher Hyer ◽  
Terrence Philbin
Keyword(s):  
Articular Cartilage ◽  
Early Detection ◽  
Metatarsal Head ◽  
Hallux Rigidus ◽  
Pain Level ◽  
Foot And Ankle ◽  
Inclusion Criteria ◽  
First Metatarsal ◽  
The Mean ◽  
One Year

Category: Midfoot/Forefoot Introduction/Purpose: Focal damage to articular cartilage and the supporting subchondral plate, commonly referred to as an osteochondral defect (OCD), can be a cause of joint pain and subsequent decreased range of motion. There are few studies specifically describing these lesions in the first metatarsophalangeal (MTP) joint, where they are traditionally grouped into hallux rigidus. There exists an opportunity for early detection and intervention with the intent to prevent deterioration and improve patient outcomes. One contemporary treatment concept is to implant particulated juvenile cartilage allograft to restore articular cartilage. The aim of our study was to review the clinical results of patients that had undergone this procedure for first metatarsal head OCDs. Methods: After IRB approval, a retrospective review of a consecutive case series was studied utilizing the records of three foot and ankle surgeons. Inclusion criteria included all adult patients who were a minimum of one year post surgery and consented to participate. Patient demographics and preoperative visual analog scale (VAS) pain level were recorded from a standardized intake sheet. From the operative note, the OCD size and location was recorded, as well as any concomitant procedures. At a minimum follow up of one year, we obtained objective measurements of arthritis grade and subjective considerations of pain and function, including VAS pain level, Foot Function Index (FFI) questionnaire, the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal scale, and an overall patient satisfaction score. Results: Nine patients met inclusion criteria, 4 males and 5 females. The average age was 41 years old (±11.77, range 21-65). The mean preoperative VAS pain score was 57.50 (±18.32, range 30-80). Four OCDs were located centrally on the first metatarsal head. The average OCD size intraoperatively was 30 mm2 (range 16-49). The average time since surgery was 3.26 years (±1.21, range 1.41-5.62). Average first MTP dorsiflexion was 41.78 degrees (±20.70, range 6-70). The average postoperative hallux rigidus classification was grade 2 (range 1-3). The mean VAS pain score improved to 5.22 (±8.44, range 0-20). The average AOFAS score was 88 (±15.91, range 52-100). The average FFI score was 8.04 (±12.60, range 0-30.6). All but one patient were satisfied or very satisfied with their results. Conclusion: At an average of 3.26 years postoperatively, patients had improved pain, did not show significant progression of their first MTP joint degeneration, and were satisfied with their results. Patients reported very little, if any, limitations in their activity level. We believe that articular damage of the first MTP should be viewed in the same way as OCD lesions in larger joints with emphasis on early detection and treatment to avoid the progression to arthritis. Particulated juvenile cartilage allograft is a valuable tool for surgeons to use in treating focal articular defects of the first metatarsal head.

scholarly journals TL 18237 - First metatarsophalangeal joint arthrodesis using a minimally invasive technique

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 112S
Author(s):  
Luiz Carlos Ribeiro Lara ◽  
Lúcio Carlos Torres ◽  
Gabriel Cervone ◽  
Juan Antonio Grajales ◽  
Fabio Lemos Rodrigues
Keyword(s):  
Minimally Invasive ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
Percutaneous Technique ◽  
First Metatarsophalangeal Joint ◽  
The Mean ◽  
Larger Sample

Introduction: Metatarsophalangeal joint arthrodesis (MTPA) is a surgical technique indicated for the treatment of hallux rigidus with advanced arthrosis and for rheumatic diseases. This classic surgery is widely used and effective; however, the use of a minimally invasive technique remains mostly unknown. Objective: To present the outcome of MTPA performed using a percutaneous technique. Methods: Hallux MTPA was performed in 8 feet from 4 patients with hallux rigidus and 4 with rheumatoid arthritis, with a higher prevalence of women than men (5 vs. 3) and a mean postoperative follow-up time of 1.5 years. The outcomes were evaluated using a modified version of the American Orthopedic Foot and Ankle Society (AOFAS) questionnaire and the union time. Results: All patients who underwent surgery showed improvements in pain and arthrodesis union at approximately 8 weeks. The mean AOFAS score increased to 85 points (of a total of 90 possible points). There were no complications, such as infection, nonunion or persistent pain. Conclusion: The percutaneous technique of hallux MTPA was effective, with satisfactory outcomes, reduced surgical invasiveness, immediate walking, rapid union with “arthrodesis take” and significant improvement in pain. However, a larger sample is required to confirm the outcomes.

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