Operative Treatment of Medial and Lateral Sesamoid AVN Through an Isolated Medial Approach

Hallucal avascular necrosis can impose a significant burden upon the affected individual. When nonoperative interventions fail, sesamoidectomy is indicated. In the rare case of both medial and lateral sesamoid avascular necrosis, previous literature recommends a staged procedure through a combination of plantar and dorsal based approaches. In this case, we present a technique for single-staged medial and lateral sesamoidectomy through a single medial approach with subsequent capsular repair, abductor tendon advancement, and flexor hallucis longus tenodesis. Preoperative and postoperative radiographic analysis as well as 1-year postoperative functional scores were completed. This single-staged medial approach may provide excellent clinical and radiographic outcomes while providing a reduction of cost, anesthesia, and rehabilitation requirements. Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.