The Use of Cheilectomy with Hemispheric Reamers in Combination with Autologous Matrix-Induced Chondrogenesis in Treatment of Patients with Hallux Rigidus

Abstract

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus (HR) is a common disease that occurs, according to the literature, in 2-10% of the population. However, currently there is no single approach to the choice of a surgical method for the treatment of this disease. It is known that the most common method at early stages of HR is cheilectomy, and the first metatarsophalangeal (1st MTP) joint arthrodesis at late stages. On the other hand, autologous matrix-induced chondrogenesis (AMIC) is known to be successfully applied in the presence of the osteochondral defects in the ankle, knee and hip joints. In this regard, we proposed to use cheilectomy in combination with this technique in treatment of patients with HR. Methods: Cheilectomy with AMIC was performed in 35 patients with HR. The operation technique included removing of the osteophytes from the metatarsal bone head and the proximal phalanx basement, clearing of the cartilage defect, microfracturing and covering the metatarsal bone head by the collagen memebrane, then - suturing the memebrane to the periosteum by absorbable thread. 16 patients underwent cheilectomy using hemispheric reamers. The results of surgical treatment were assessed using visual analog scale (VAS) of pain, AOFAS scale and range of motion (ROM) in 1st MTP joint. Also foot X-ray and MRI before and 3, 6, 12 months after the surgery were used. Results: In patients who underwent cheilectomy without reamers (1st group), the median ROM before the surgery was 20o, VAS of pain - 72.5, AOFAS - 49. As for the patients who underwent cheilectomy with reamers (2nd group), the median ROM was also 20o, VAS of pain - 70, AOFAS - 52.In the 1st group, after a year of observation, the median VAS of pain decreased to 10, ROM increased to 72.5o and AOFAS - to 82.5.In the 2nd group, after 12 months the median VAS of pain decreased to 7.5, ROM increased to 77o, AOFAS - to 85.On the radiographs 12 months after the surgery, there was some narrowing of the joint space compared to the first day after the operation. However, the ROM in the 1st MTP joint, on the contrary, increased. Conclusion: The results showed that cheilectomy in combination with AMIC allows to relieve pain and significantly improve the quality of life of patients with HR; the results in patients who underwent cheilectomy using hemispheric reamers were better, therefore, in most cases we recommend to use these reamers. Also, this technique, unlike isolated cheilectomy or arthrodesis, can be used at any stage of HR.