Metatarsophalangeal Joint Reconstruction Using Talar Osteochondral Allograft following a Failed Dorsal Cheilectomy.

IF 0.4 Q4 ORTHOPEDICS
Case Reports in Orthopedics Pub Date : 2022-09-19 eCollection Date: 2022-01-01 DOI:10.1155/2022/6359108
Alexandria J Lichtl, Kelly L Vittetoe, Connie P Friedman, Hardik P Parikh, Christopher S Lee
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Abstract

Dorsal cheilectomy is often used as a first-line surgical treatment for hallux rigidus; however, revision surgery is needed in nearly 9% of cases. One option for revision surgery is interpositional arthroplasty, which is designed to preserve joint motion and is favorable in young, active populations. This case discusses a young female patient with persistent, painful hallux rigidus and a large osteochondral defect despite prior dorsal cheilectomy. We performed an interpositional arthroplasty of the first metatarsophalangeal joint using an osteochondral allograft from the talus. At three-year follow-up, she had greatly improved function and was able to run without pain. To our knowledge, this is the first documented use of an osteochondral allograft from the talus in conjunction with metatarsophalangeal joint interpositional arthroplasty for treatment of hallux rigidus and a severe osteochondral defect. This technique introduces osseous subchondral scaffolding as well as mature hyaline cartilage into an osteochondral lesion, thereby reestablishing proper joint architecture and congruent articulation and ultimately improving range of motion and reducing pain. We present this technique as an experimental treatment option for restoring both the integrity and function of the metatarsophalangeal joint following trauma, osteochondritis dissecans, or prior operative failure in patients who wish to delay metatarsophalangeal joint fusion.

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背侧颧骨切除术失败后距骨软骨异体移植重建跖趾关节。
趾背切除常被用作拇僵硬的一线手术治疗;然而,近9%的病例需要进行翻修手术。翻修手术的一种选择是关节置换术,其目的是保持关节活动,适合年轻、活跃的人群。本病例讨论了一位年轻女性患者,尽管先前进行了背侧颧骨切除术,但仍患有持续性、疼痛性拇僵直和大面积骨软骨缺损。我们使用距骨骨软骨同种异体移植物对第一跖趾关节进行了置换术。在三年的随访中,她的功能有了很大的改善,并且能够毫无痛苦地跑步。据我们所知,这是第一次文献记载的使用距骨骨软骨异体移植物联合跖趾关节置换术治疗拇趾僵硬和严重骨软骨缺损。该技术将骨性软骨下支架和成熟的透明软骨引入骨软骨病变,从而重建适当的关节结构和一致的关节,最终提高活动范围并减轻疼痛。我们提出该技术作为一种实验性治疗选择,用于在创伤、夹层性骨软骨炎或先前手术失败的患者延迟跖趾关节融合后恢复跖趾关节的完整性和功能。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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55
审稿时长
14 weeks
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