Surgical Treatment for Müller-Weiss Disease

Abstract

Category: Midfoot/Forefoot Introduction/Purpose: Müller-Weiss disease is an uncommon osteonecrosis of the tarsal navicular of unknown etiology. Most of them could be treated by non-surgical methods. But some severe deformity and fail to conserved methods. In those cases, surgery may be a reasonable approach. Methods: From January 2005 to Septermber 2016, we treated 69 patients suffering from Müller-Weiss disease, using the surgical arthrodesis of the talonavicular joint and naviculocuneiform joint with tricortical autologous iliac crest block fixed by screws and plate. Results: All Maceira grades were included. We reviewed the medical records of the patients and took the radiological preoperative and postoperative evaluation. The preoperative and postoperative clinical functions were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot Scale. To treat Müller-Weiss disease, we introduced a surgical arthrodesis of the talonavicular joint and naviculocuneiform joint with tricortical autologous iliac crest bone block fixed by screws and plate. The median follow up was 26 months. All the feet fused solidly. The median time for complete fusion was 13 weeks. The median AOFAS ankle-hindfoot score improved from 45 points preoperatively to 86 points at last follow-up. Conclusion: The results of this series demonstrate the arthrodesis of the TNJ and NCJ with tricortical autologous iliac crest graft is a reasonable way for treatment of Müller -Weiss disease. Based on our experience with the patients, we believe that emphasis of the restoration of the length and alignment of the medial column could achieve a good outcome.