Metatarsocuneiform Arthrodesis Research Articles

The biomechanical analysis of first metatarsocuneiform arthrodesis using the finite element method: A comparison of plate osteosynthesis in different positions

The biomechanical analysis of first metatarsocuneiform arthrodesis using the finite element method: A comparison of plate osteosynthesis in different positions

Functional restoration and risk of non-union of the first metatarsocuneiform arthrodesis for hallux valgus: A finite element approach

First metatarsocuneiform arthrodesis is one of the surgical interventions to correct hallux valgus, especially those with hypermobile first ray. There is lacking of biomechanical investigations to assess this operation. The objective of this study was to explore the functional restoration and the risk of non-union after the surgery via finite element analysis.A three-dimensional foot model was constructed from a female aged 28 via magnetic resonance imaging. Thirty bones and encapsulated bulk tissue were modeled. Walking stance was simulated by the gait analysis data of the same participant. Parts of the first metatarsal and cuneiform were resected and the bone graft was assigned with the same stiffness as adjacent bones to resemble the surgery of first metatarsocuneiform arthrodesis.The third principal stress of the first metatarsal at midstance (25% stance) and push off (60% stance) was increased by 76% and 139% respectively after the operation, while that of the second metatarsal was decreased by 14% and 66%. The operation reduced the medial deviation of the first metatarsal head by about 3.5mm during initial push off (60% stance). Besides, the bone graft could experience tensile stress inferiorly (26.51MPa).In conclusion, the increase of stress on the first metatarsal and the reduced medial excursion of the first metatarsal head after the simulated operation reflected that metatarsocuneiform arthrodesis could restore the load-bearing function of the first ray. However, inter-fragmentary compression could not be guaranteed. The appropriate course of hardware and non-weight-bearing protocol should be noted and further investigated.

Lapidus Arthrodesis with a Single Lag Screw and a Locking H-Plate

The aim of this pilot study was to assess if using an interfragmental lag screw and a Darco ® locking H-plate for the modified Lapidus arthrodesis in the treatment of hallux abducto valgus deformity (1) would allow for earlier weight bearing than previously described and (2) would indicate whether any changes would occur radiographically with the earlier weight bearing. Twenty-one metatarsocuneiform arthrodeses, in 18 patients, were retrospectively evaluated through chart review and postoperative radiographs. Original diagnoses included painful hallux abducto valgus and osteoarthritis of the first metatarsocuneiform joint. The mean age of the patients was 48 (range, 16 to 70) years. The mean follow-up duration was 38.5 (range, 29 to 60) months. The overall radiographic osseous union rate was 90.5% (19/21 feet), although there were 2 asymptomatic nonunions. There were no cases of fixation failure, and the surgical correction was preserved on follow-up radiographs. Overall, the mean time to full weight bearing was 4.7 (range, 3 to 7.5) weeks, and it was a mean of 8 (range, 7 to 10) weeks before the patient was back to wearing comfortable shoes. The authors concluded that metatarsocuneiform arthrodesis fixated with 1 interfragmentary lag screw and a Darco ® locking H-plate provides sufficient stability to allow earlier weight bearing than has been previously described with other internal fixation constructs.

Immediate Weight Bearing Following Modified Lapidus Arthrodesis

First metatarsocuneiform arthrodesis (Lapidus procedure) can provide powerful correction of mild to moderate hypermobile or severe hallux valgus, although a period of non–weight bearing may be necessary. The purpose of this retrospective investigation was to compare patients who underwent a modified Lapidus arthrodesis with 2 screws plus an additional “neutralization” Kirschner-wire with immediate partial weight-bearing in a removable boot, with a control group without the Kirschner-wire who were non–weight bearing for 6 weeks in a short leg cast. A total of 41 consecutive patients from January 2004 to January 2007 were included in this comparative cohort study. There were no significant radiographic changes between immediate and final 6-month postoperative radiographs in regard to first intermetatarsal angle (°) and first ray elevation measurements (first to second metatarsal head elevation [mm] and Seiberg index [mm]) within groups ( P = .49, .47, and .54, and 95% confidence intervals of [–2.1, 1.2], [–0.32, 2.03], and [–0.82, 0.44], respectively) or between groups ( P = .259, .67, and .083, and 95% confidence intervals of [–4.2, 1.2], [–1.39, 0.91], and [–1.77, 0.12], respectively), as computed with paired 2-sample t tests. Stratified Mantel-Haenszel analyses revealed both groups to be comparable relative to severity of deformity, gender, age, smoking history, perioperative immunosuppressant use, and other comorbidities. No nonunions or malunions where observed in either group. The use of a temporary Kirschner-wire as a third point of fixation may enable immediate protected weight bearing, by minimizing load placed on the crossed lag screw construct, in patients undergoing modified Lapidus arthrodesis.

Instability of the First Metatarsal-Cuneiform Joint: Diagnosis and Discussion of an Independent Pain Generator in the Foot

First metatarsocuneiform (MC) instability is recognized as a pathologic contributor to hallux valgus. There are no studies identifying the first MC joint as an independent pain generator in the foot that may require surgical arthrodesis for its management. The authors reviewed the records of all patients with this newly described pathology in the first MC joint. There were 61 patients with 85 feet who underwent a fluoroscopically guided local anesthetic injection into the first metatarsocuneiform joint to assess pain relief. Patient's complaints, physical exam findings, treatment decisions, patient characteristics, and radiographic findings were evaluated. Seventy-nine percent of patients (67/85) injected had relief of their symptoms. Eight or these 67 patients were eventually treated with first MC arthrodesis with complete relief of symptoms. The average time from onset of symptoms to presentation was 21 (range, 1 to 72) months. Eighty-five percent of feet (72/85) had multiple previous diagnoses. Radiographic plantar widening of the first M-C joint on weightbearing views was inconsistent with pathology. The first MC joint is an independent pain generator in the foot that can have variable presentations. Radiographic data can often be helpful, but clinical exam findings are paramount in the diagnosis. Fluoroscopically-guided long acting local anesthetic injections of this joint are helpful in the diagnosis, especially in the patient with multiple possible pain generators in the foot and ankle. Failure to recognize the first MC joint as a source of pain may lead to delay in treatment, misdiagnosis, and mistreatment of foot pathology.

Crossed Screws versus Dorsomedial Locking Plate with Compression Screw for First Metatarsocuneiform Arthrodesis: A Cadaver Study

We hypothesized that a dorsomedial locking plate with adjunct screw compression would provide superior rigidity compared to crossed screws for first metatarsocuneiform (MTC) arthrodesis. In ten matched lower extremity pairs, specimens in each pair were randomly assigned to receive screw fixation or plate with screw fixation. Bone mineral density (BMD) was measured. For the crossed-screw construct, two 4.0-mm cannulated screws were used. One screw was inserted dorsal to plantar beginning from the first metatarsal 10 to 15 mm distal to the joint, and the second was inserted from the cuneiform 8 to10 mm proximal to the joint, medial to the first screw, into the first metatarsal. For the plate construct, a 4.0-mm cannulated compression screw was inserted from the dorsal cortex of the first metatarsal to the plantar aspect of the medial cuneiform. A locking plate was inserted dorsomedially across the MTC joint. Specimens were loaded in four-point bend configuration (displacement rate, 5 mm/min) until failure of the fixation or 3-mm deformation. An extensometer was used to measure deformation. There was no difference in load to failure or stiffness between the two groups. BMD was positively correlated with load to failure in the screw (r = 0.893, p = 0.001) and the plate (r = 0.858, p = 0.001) construct. The plate construct with compression screw did not show different rigidity as compared with the screw construct with the numbers available. Further investigation of a dorsomedial plate with adjunct screw compression may be warranted for first MTC arthrodesis.

Calcaneocuboid Distraction Arthrodesis and First Metatarsocuneiform Arthrodesis for Correction of Acquired Flatfoot Deformity in a Cadaver Model

Lateral column lengthening has been associated with residual forefoot supination and symptomatic lateral overload in treatment of acquired flatfoot. A medial column procedure may be useful to redistribute load to the medial column. We evaluated radiographic and pressure changes in a severe flatfoot model with lateral column lengthening and investigated the effect of an added first metatarsocuneiform arthrodesis. Ten cadaver specimens were loaded in simulated double-legged stance, and radiographic and pressure data were collected for all tested states. Calcaneocuboid arthrodesis was done with a 10-mm foam wedge. Residual forefoot varus was corrected through the first metatarsocuneiform joint. Differences in the mean lateral talar-first metatarsal angle, talonavicular angle, talocalcaneal angle, and calcaneal pitch were significant between the intact foot and the flatfoot. After calcaneocuboid distraction arthrodesis and tendon transfer, the lateral talar-first metatarsal angle, talonavicular angle, and calcaneal pitch were significantly different from the flatfoot. After added first metatarsocuneiform arthrodesis, the talonavicular angle was not significantly different from the intact foot. Lateral forefoot pressure increased in the flatfoot after lateral column lengthening but was not significantly different from the intact foot after first metarsocuneiform arthrodesis was added. Adding first metatarsocuneiform arthrodesis to calcaneocuboid distraction arthrodesis for treatment of flatfoot deformity provided improvement in radiographic and pedobarographic parameters of a severe model of stage II posterior tibial tendon dysfunction.

First metatarsocuneiform arthrodesis and Reverdin-Laird osteotomy for treatment of hallux valgus: An intermediate-term retrospective outcomes study

The authors present a retrospective study of 14 patients (20 feet) treated with first metatarsocuneiform arthrodesis and Reverdin-Laird osteotomy and distal soft tissue alignment for hallux valgus associated with hypermobility of the first ray and an increased proximal articular set angle. The purpose of this study was 3-fold: (1) to determine clinical outcome of this procedure combination, (2) to evaluate the effect of this procedure on the radiographic parameters of hallux valgus, and (3) to determine the degree of first ray shortening. At a mean 50.1 months postoperatively, patients were evaluated according to the American Orthopedic Foot and Ankle Society's Hallux-First Metatarsophalangeal-Interphalangeal Clinical Rating Scale. Preoperative and follow-up radiographs were compared for changes in the following measurements: 1-2 intermetatarsal angle (IMA), hallux abduction angle (HAA), proximal articular-set angle (PASA), and metatarsal protrusion distance (MPD). Statistical analysis using the Student t test showed a significant increase in total scores from a mean 43.6 to 92.6 of 100. A significant decrease was found in the IMA from a mean 16.9° to 7.1°, in the HAA from a mean 37.1° to 5.2°, in the PASA from a mean 20.3 ° to 3.4°( P < .001), and a significant change in the was found in the MPD of 7.7 mm ( P < .001). Given the high rating scale scores, first ray shortening did not appear to hamper our patients' clinical outcome. (The Journal of foot & Ankle Surgery 42(2):77-85, 2003)

First metatarsocuneiform arthrodesis: Technical considerations and technique modification

Triplane malalignment of the first ray is frequently associated with instability and suboptimal spatial positioning at the first metatarsocuneiform joint (MCJ). The first metatarsocuneiform arthrodesis provides an effective means of addressing hypermobility in association with multiplanar first metatarsal malalignment. The first MCJ has a characteristic concave-convex surface topography that can allow the first metatarsal to translate within the transverse and sagittal planes. A method of "anatomical arthrodesis" of the first MCJ is described that utilizes the joint's unique topography to assist in the process of repositioning the first metatarsal. A step-by-step description of the procedure is provided with emphasis placed on identifying and highlighting unique areas of difficulty.

Biomechanics of the first ray. Part III. Consequences of lapidus arthrodesis on peroneus longus function: A three-dimensional kinematic analysis in a cadaver model

It has long been proposed that first metatarsocuneiform joint (FMCJ) arthrodesis, also known as Lapidus arthrodesis, can realign the first ray and permanently lock the FMCJ to control hypermobility. Left unanswered is the functional consequence of peroneus longus (PL) after such a procedure. In this study, the effects of PL on the medial column of the foot before and after metatarsocuneiform arthrodesis were evaluated. Seven fresh-frozen cadaver specimens with an intact foot and ankle were mounted on a custom-made acrylic frame and loaded to 400 N while midstance motor function was simulated with pneumatic actuators. Three-dimensional radiowave tracking transducers were attached to the first metatarsal, medial cuneiform, navicular, and talus to measure osseous movements while tensile loads of 0% to 100% of PL predicted force was applied. Simulated arthrodesis of the metatarsocuneiform joint and then additionally the intercuneiform 1-2 joint was achieved with titanium pins and then retested to determine any change in effect from PL. Significant frontal plane eversion of the medial cuneiform (p = .016) and dorsiflexion of the talus (p = .045) occurred after Lapidus arthrodesis was achieved. This suggests that arthrodesis at the first metatarsocuneiform joint increases the efficiency of PL stabilizing action on the medial column.

Biomechanical analysis of the first metatarsocuneiform arthrodesis

This investigation was designed to help define the unique loading characteristics of the first metatarsocuneiform arthrodesis procedure. Part I of this investigation employed nine fresh frozen, matched-pair cadaveric specimens. One specimen in each pair had the subchondral plate removed from the opposing joint surfaces, while the remaining specimen had only the articular cartilage removed. All specimens were stabilized in an identical manner utilizing two 3.5-mm cortical screws. Part II of the investigation also utilized nine fresh frozen, matched-pair cadaveric specimens. Only the articular cartilage was removed prior to placement of fixation. All specimens were stabilized with two crossing 3.5-mm cortical screws. Placement of a third screw was randomized between specimens of a matched pair. Specimens were loaded to failure in cantilever bending utilizing a materials tester. There was a statistically significant (p = .04) greater load to failure and bending moment in specimens with an intact subchondral plate. Values for construct stiffness were not found to be significantly different (p = .95) between specimens with and without a subchondral plate. Although the addition of a third screw increased the load to failure and bending moments, differences were not found to be statistically different (p = .11-.21) from two screws. Preserving the subchondral plate will enhance the stability of the first metatarsocuneiform arthrodesis. Two or three screws can be employed to shield the fusion site from loading; however, three screws were shown to be more effective than two.

Correction of Hallux Valgus with Metatarsocuneiform Arthrodesis and Distal Soft-Tissue Realignment

Correction of Hallux Valgus with Metatarsocuneiform Arthrodesis and Distal Soft-Tissue Realignment