Abstract
PurposeThis study compares the amount of joint preparation and first ray shortening following first metatarsophalangeal (MTP) joint fusion utilizing open conical reaming versus arthroscopic technique.MethodsTen below-knee cadaver specimens were randomly assigned to undergo either open or arthroscopic first MTP fusion. Following fixation, first ray length measurements were obtained from pre-operative and post-operative radiographs and were used to determine first ray shortening. Additionally, the ratio of first ray length to second ray length was calculated both pre-operatively and post-operatively and compared between the two approaches. All ankles were then completely dissected, and prepared surface areas were demarcated. ImageJ photo analysis software (National Institutes of Health, Bethesda, MD, USA) was used to calculate the percentage of prepared and unprepared cartilage of each articular surface of each specimen. ResultsOverall, the open approach resulted in 99.3% ± 1.6% joint surface preparation, whereas the arthroscopic approach yielded 92.9% ± 7.2% (p = 0.089). On average, the head of the first metatarsal was significantly more prepared with the use of the open approach (99.5% ± 1.1%) than with the arthroscopic approach (96.6% ± 1.5%) (p = 0.008). However, with respect to the base of the phalanx, the average difference in preparation between the arthroscopic approach and the open approach was not statistically significant (90.0% ± 12.8% vs. 99.0% ± 2.2%; p = 0.160). The average amount of first ray shortening in the arthroscopic approach was 2.2 ± 1.8 mm compared to 2.1 ± 3.2 mm in the open approach (p = 0.934). The average change in the first to second ray length ratio was 0.02 for both approaches (p = 0.891).ConclusionArthroscopic first MTP fusion can be used to achieve joint preparation comparable to open technique while maintaining first ray length.
Highlights
Open and arthroscopic first metatarsophalangeal (MTP) joint fusions are effective treatments for a variety of conditions such as rheumatoid arthritis, hallux rigidus, and severe hallux valgus [1]
The open approach resulted in 99.3% ± 1.6% joint surface preparation, whereas the arthroscopic approach yielded 92.9% ± 7.2% (p = 0.089)
The average amount of first ray shortening in the arthroscopic approach was 2.2 ± 1.8 mm compared to 2.1 ± 3.2 mm in the open approach (p = 0.934)
Summary
Open and arthroscopic first metatarsophalangeal (MTP) joint fusions are effective treatments for a variety of conditions such as rheumatoid arthritis, hallux rigidus, and severe hallux valgus [1]. Singh et al compared first MTP joint fusion utilizing flat cut or conical reaming technique for bone preparation with regard to the amount of first ray shortening that occurs and found no significant difference between both techniques [4]. These two techniques require an open approach to access the joint for surface preparation. The first study describing first MTP arthroscopy was published in 1972, but due to a number of factors, arthroscopic treatments for first MTP joint have not fully spread [7,8] This could be attributed to the learning curve that comes with arthroscopic surgery and the proven success of the open approach in first MTP fusion
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