Arthroscopic Interpositional Arthroplasty of the Second Metatarsophalangeal Joint

Tun Hing Lui

doi:10.1016/j.eats.2016.08.008

. 2016 Nov 21;5(6):e1333–e1338. doi: 10.1016/j.eats.2016.08.008

Arthroscopic Interpositional Arthroplasty of the Second Metatarsophalangeal Joint

Tun Hing Lui ^1,^∗

PMCID: PMC5263859 PMID: 28149733

Abstract

Painful degenerative diseases of the second metatarsophalangeal joint are frequently progressive and difficult to treat. Surgical options for the degenerated second metatarsophalangeal joint include joint debridement and synovectomy, drilling and microfracture, core decompression, dorsal closing-wedge metatarsal osteotomies, joint arthroplasty (implant or interpositional), elevation of the depressed articular fragment and bone graft, distraction arthroplasty, osteochondral plug transplantation, osteochondral distal metatarsal allograft reconstruction, and resection arthroplasty (phalangeal base or metatarsal head). This technical note describes the arthroscopic approach of interpositional arthroplasty of the second metatarsophalangeal joint using the extensor digitorum brevis tendon. It is indicated in adult patients with extensive involvement of the metatarsal head cartilage, especially when cartilage degeneration of the proximal phalanx is also present. It is contraindicated if there is significant bone loss of the metatarsal head or the extensor digitorum brevis tendon is flimsy.

Painful degenerative diseases of the second metatarsophalangeal (MTP) joint are frequently progressive and difficult to treat. Freiberg disease—osteochondrosis of the metatarsal heads—is one of the most common causes of painful second MTP degeneration and was first reported in 1914.¹ Smillie² classified Freiberg infraction into 5 stages. In the early stage, patients are treated conservatively with modification of activities and the use of an orthosis and metatarsal bars.³ Nonoperative treatment is based on decreasing foot pressure and unloading the affected metatarsal. Spontaneous healing with remodeling may occur in early stages of the disease.⁴ Operative treatment is indicated when conservative measures cannot relieve the symptoms. In the early stages of the disease (stages I, II, and III), it is possible to restore the joint congruity; joint debridement, elevation of the depressed articular fragment and bone graft, and metatarsal osteotomy can be considered.5, 6, 7 On the other hand, it is difficult to restore the joint congruity in the later stages (stage IV or V), and the surgical options include joint arthroplasty, the Keller procedure, shortening metatarsal osteotomy, and osteochondral distal metatarsal allograft reconstruction.3, 7, 8 Arthroscopic management of this disease has been reported.9, 10, 11, 12, 13 A protocol for arthroscopic management of this disease was suggested by Carro et al.¹² Arthroscopic removal of loose bodies and arthroscopic debridement are recommended in the early stages in all age groups. Arthroscopic osteochondral transplantation should be considered in late adolescence or early adulthood with late disease. An arthroscopic Keller procedure is reserved as a salvage procedure.¹²

This technical note describes details of arthroscopic interpositional arthroplasty of the second MTP joint using the extensor digitorum brevis (EDB) tendon. It is indicated in adult patients with extensive involvement of the metatarsal head cartilage, especially when cartilage degeneration of the proximal phalanx is also present.¹³ It is contraindicated if there is significant bone loss of the metatarsal head or the EDB tendon is flimsy (Table 1).

Table 1.

Indications and Contraindications of Arthroscopic Interpositional Arthroplasty of Second Metatarsophalangeal Joint

Indications

The technique is indicated in adult patients with extensive involvement of the metatarsal head cartilage, especially when cartilage degeneration of the proximal phalanx is also present.

Contraindications

There is significant bone loss of the metatarsal head.

The extensor digitorum brevis tendon is flimsy.

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Technique

Preoperative Planning and Patient Positioning

Preoperative clinical examination should confirm that the pain originates from the second MTP joint. Radiographs may show a decrease in the joint space, collapse of the metatarsal head, or degenerative change of the second MTP joint. Magnetic resonance imaging can confirm the presence of a chondral lesion and synovitis.

The patient is placed in the supine position with a thigh tourniquet to provide a bloodless operative field. A 1.9-mm 30° arthroscope (Henke Sass Wolf, Tuttlingen, Germany) is used for this procedure.

Portal Placement

Arthroscopy of the second MTP joint is performed through the dorsomedial and dorsolateral portals, which are located at the second MTP joint level, medial and lateral to the extensor tendons, respectively (Fig 1). Three-millimeter incisions are made at the portal sites. The subcutaneous tissue is bluntly dissected down to the joint capsule by a hemostat, and the capsule is perforated by the tip of the hemostat. The portals can be switched as the viewing and working portals. No continuous traction of the joint is used.

Fig 1 — Arthroscopic interpositional arthroplasty of right second metatarsophalangeal joint. Second metatarsophalangeal arthroscopy is performed through the dorsomedial portal (DMP) and dorsolateral portal (DLP). The DMP and DLP are located at the second metatarsophalangeal joint level, medial and lateral to the extensor tendons, respectively. The DLP is the viewing portal, and the DMP is the working portal.

Arthroscopic Synovectomy and Debridement of Damaged Cartilage

The second MTP joint is examined arthroscopically to determine the status of the articular cartilage and the presence of synovitis (Fig 2). Arthroscopic synovectomy is performed with an arthroscopic shaver (Dyonics; Smith & Nephew, Andover, MA) if synovitis is present (Fig 3). The damaged cartilage is debrided, and any loose fragments are removed. The portals can be switched as the viewing and working portals to ensure complete assessment and debridement of the joint. With the dorsomedial portal as the viewing portal, an arthroscopic probe (Acufex; Smith & Nephew) is inserted into the joint through the dorsolateral portal. The distance from the dorsolateral portal to the center of the chondral defect is measured by the marking at the stem of the probe.

Fig 3 — Arthroscopic interpositional arthroplasty of right second metatarsophalangeal joint. The dorsolateral portal is the viewing portal, and the dorsomedial portal is the working portal. Arthroscopic view shows synovitis at the medial side of the joint. (AS, arthroscopic shaver; MT, metatarsal head; S, inflamed synovium.)

Harvest and Preparation of EDB Tendon Graft

The EDB tendon is identified just lateral to the extensor digitorum longus tendon at the dorsolateral portal incision. Tension on the EDB tendon is achieved by lifting it with a hemostat. The tendon is traced proximally, and a transverse incision is made at its proximal end. The EDB tendon is cut at its proximal end and is retrieved to the dorsolateral portal incision. The tendon graft is rolled into a ball and is sutured with No. 0 Vicryl (Ethicon [Johnson & Johnson], Cincinnati, OH) with long stay suture. The length of the stalk of the tendon graft is equal to the distance between the dorsolateral portal and the center of the chondral defect (Fig 4).

Fig 4 — Arthroscopic interpositional arthroplasty of right second metatarsophalangeal joint. (A) The extensor digitorum brevis (EDB) tendon is identified at the dorsolateral portal (DLP) and the proximal incision. (B) The EDB tendon is cut at the proximal incision and is retrieved to the DLP. (C) The tendon graft is rolled and sutured with long stay suture.

Arthroscopically Guided Interpositional Arthroplasty

The dorsomedial portal is the viewing portal. The stay sutures are passed through the plantar plate by means of a straight eyed needle (FavorMed, Ningbo, China) through the dorsolateral portal. The straight eyed needle should pass over the center of the chondral defect before it pierces through the plantar plate (Fig 5). This ensures that the EDB tendon ball will be seated on the center of the chondral defect. The needle and the stay sutures pass through the plantar plate, the fibrous flexor tendon sheath, and the plantar skin. The tendon ball is then brought into the joint and is seated on the chondral defect (Fig 6). The exit point of the stay suture at the plantar skin is dilated by the tip of a hemostat. The suture is tied and stabilizes the tendon ball by forming a bulky knot on the surface of the fibrous tendon sheath (Fig 7, Video 1). The EDB tendon insertion can also be sutured to the dorsal capsule of the second MTP joint to prevent pulling out of the tendon ball by tension of the EDB tendon (Table 2). Postoperatively, the patient is allowed to walk with a hard-bottom postoperative sandal for 4 to 6 weeks. Active and passive toe mobilization is allowed afterward.

Fig 5 — Arthroscopic interpositional arthroplasty of right second metatarsophalangeal joint. The dorsomedial portal (DMP) is the viewing portal, and the dorsolateral portal (DLP) is the working portal. (A) The straight eyed needle loaded with the stay suture of the extensor digitorum brevis (EDB) tendon graft is inserted through the DLP. (B) The needle (N) passes over the center of the chondral defect of the metatarsal head (MT) and pierces through the plantar plate (PP).

Fig 6 — Arthroscopic interpositional arthroplasty of right second metatarsophalangeal joint. The dorsomedial portal is the viewing portal, and the dorsolateral portal is the working portal. The extensor digitorum brevis (EDB) tendon ball is seated on the chondral defect of the metatarsal head (MT). The stay suture (SS) of the tendon passes through the plantar plate (PP).

Fig 7 — Arthroscopic interpositional arthroplasty of right second metatarsophalangeal joint. (A) The exit point of the stay suture at the plantar skin is dilated by the tip of a hemostat. (B) The suture is tied and stabilizes the extensor digitorum brevis tendon ball by forming a bulky knot on the surface of the fibrous tendon sheath. (PEP, plantar exit point.)

Table 2.

Pearls and Pitfalls of Arthroscopic Interpositional Arthroplasty of Second Metatarsophalangeal Joint

Pearls

At the proximal incision, the extensor digitorum brevis tendon is deep to the long extensor tendons to the toes.

The distance between the dorsolateral portal and the center of the chondral defect can be measured with an arthroscopic probe.

The length of the stalk of the tendon graft should be the same as the distance between the dorsolateral portal and the center of the chondral defect.

The needle should pass over the center of the chondral defect before it pierces through the plantar plate.

Pitfalls

The plantar exit point should only be dilated by the tip of the hemostat.

Blunt dissection at the plantar exit point should be avoided to prevent painful plantar scar formation.

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Discussion

Surgical options for the degenerated second MTP joint include joint debridement and synovectomy, drilling and microfracture, core decompression, dorsal closing-wedge metatarsal osteotomies, joint arthroplasty (implant or interpositional), elevation of the depressed articular fragment and bone graft, distraction arthroplasty, osteochondral plug transplantation, osteochondral distal metatarsal allograft reconstruction, and resection arthroplasty (phalangeal base or metatarsal head).2, 3, 4, 5, 6, 7, 8, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24 Excision of the metatarsal head is not recommended because of the risk of shortening of the toe, a break in the alignment of the metatarsal arch and transfer metatarsalgia, instability of the MTP joint and deformity of the toes, hallux valgus, and gait disturbance.22, 25 Joint replacement arthroplasty has been used in the advanced stages of the disease.¹⁷ In patients with high levels of physical activity, such as active adolescents, silicone or hemiarthroplasty implants can result in several problems, including inappropriate fit, poor material strength, implant loosening, local bony resorption, a lack of toe purchase, infection, hardware irritation, and transfer metatarsalgia.²³ Nowadays, the use of a silicone implant is not recommended for the management of second MTP degenerative disease in active adults.22, 23 Furthermore, the evidence in published studies is insufficient to support the use of metallic or ceramic materials.22, 23 A number of authors have reported information on the success of dorsal wedge osteotomies. However, there are no long-term results to identify transfer metatarsalgia.²² Moreover, excessive dissection and/or poor fixation technique can cause major problems such as infection, soft-tissue irritation, malunion, nonunion, aseptic necrosis, and metacarpal shortening.22, 23

El-Tayeby²⁶ reported an interpositional arthroplasty for Freiberg disease. The tendon of the extensor digitorum longus is used for surfacing and as a spacer. The effect of pain relief is satisfactory after this procedure, although the range of motion of the MTP joint did not improve. Interposition of the extensor digitorum longus after resection arthroplasty of the lesser MTP joints for rheumatoid forefoot deformity has also been reported.¹⁶ In addition, interposition arthroplasty using the flexor digitorum longus has been used for degeneration of the MTP joint with an associated hammer toe deformity.¹⁸ The authors reported good relief of pain and stiffness associated with MTP joint arthrosis by this interposition arthroplasty technique.¹⁸ Other interposition materials for treatment of osteochondritis of the second metatarsal head include the MTP capsule,¹⁹ EDB tendon,²⁰ and palmaris longus tendon.²³

The reported technique has the advantages of a detailed examination and debridement of the joint, better cosmetic results, and minimal soft-tissue dissection. Tendon interposition into the joint can facilitate the maintenance of joint space and prevent bone impingement during dorsiflexion or plantar flexion of the joint.¹³ In cases in which a bone defect occurs in the metatarsal head, varus or valgus toe deformity may occur. Appropriate placement of the tendon ball to fill up the bone defect can help correct the toe deformity. The EDB tendon is locally available and is free of additional donor-site morbidity, and the major dorsiflexor of the toe (extensor digitorum longus) can be preserved.13, 20 Preservation of the distal insertion of the EDB tendon may preserve some of the blood supply to the tendon graft. Moreover, the use of autograft eliminates potential foreign body reactions and risk of infection.20, 23 The procedure is not difficult technically and can be performed on an outpatient basis with the usual arthroscopic instruments. Potential risks of this technique include formation of painful plantar scar, displacement of the tendon graft, and limitation of active dorsiflexion of the toe because of loss of EDB action (Table 3).

Table 3.

Advantages and Risks of Arthroscopic Interpositional Arthroplasty of Second Metatarsophalangeal Joint

Advantages

Better cosmesis is achieved.

Minimal soft-tissue dissection is necessary.

Detailed examination and debridement of the joint are possible.

Tendon interposition into the joint can facilitate the maintenance of joint space and prevent bone impingement during dorsiflexion or plantar flexion of the joint.

Tendon interposition can fill up the bone defect of the metatarsal head and help correct the toe deformity.

EDB tendon is locally available and free of additional donor-site morbidity, and the major dorsiflexor of the toe (extensor digitorum longus) can be preserved.

Preservation of the distal insertion of the EDB tendon may preserve some of the blood supply to the tendon graft.

Use of autograft eliminates potential foreign body reactions and risk of infection.

The technique is not difficult technically and can be performed on an outpatient basis with the usual arthroscopic instruments.

Risks

Painful plantar scar formation

Displacement of tendon graft

Limitation of active dorsiflexion of toe because of loss of EDB action

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EDB, extensor digitorum brevis.

Footnotes

The author reports that he has no conflicts of interest in the authorship and publication of this article.

Supplementary Data

Video 1

Arthroscopic interpositional arthroplasty of right second metatarsophalangeal joint. Second metatarsophalangeal arthroscopy is performed through the dorsomedial and dorsolateral portals. The dorsolateral portal is the viewing portal. The chondral defect is debrided and synovectomy is performed through the dorsomedial portal. The extensor digitorum brevis tendon graft is prepared and rolled into a ball. The dorsomedial portal is the viewing portal. The straight eyed needle preloaded with the stay suture is inserted through the dorsolateral portal. The needle passes over the chondral lesion of the metatarsal head before it pierces through the plantar plate. The tendon ball is then brought into the joint and is seated on the chondral lesion. The plantar exit point of the stay suture is dilated by the tip of a hemostat, and the stay suture is tied on the surface of the fibrous tendon sheath.

Download video file^{(14MB, mp4)}

References

1.Freiberg A.H. Infraction of the second metatarsal bone. Surg Gynecol Obstet. 1914;19:191–193. [Google Scholar]
2.Smillie I.S. Treatment of Freiberg's infraction. Proc R Soc Med. 1967;60:29–31. doi: 10.1177/003591576706000117. [DOI] [PMC free article] [PubMed] [Google Scholar]
3.Trott A.W. Developmental disorders. In: Jahss M.H., editor. Ed 2. Vol III. WB Saunders; Philadelphia: 1991. pp. 607–616. (Disorders of the foot and ankle). [Google Scholar]
4.Talusan P.G., Diaz-Collado P.J., Reach J.S., Jr. Freiberg's infraction: Diagnosis and treatment. Foot Ankle Spec. 2014;7:52–56. doi: 10.1177/1938640013510314. [DOI] [PubMed] [Google Scholar]
5.Helal B., Gibb P. Freiberg's disease: A suggested pattern of management. Foot Ankle. 1987;8:94–99. doi: 10.1177/107110078700800205. [DOI] [PubMed] [Google Scholar]
6.Gauthier G., Elbaz R. Freiberg's infraction: A subchondral bone fatigue fracture. Clin Orthop Relat Res. 1979;(142):93–95. [PubMed] [Google Scholar]
7.Smith T.W.D., Stanley D., Rowley D.I. Treatment of Freiberg's disease. A new operative technique. J Bone Joint Surg Br. 1991;73:129–130. doi: 10.1302/0301-620X.73B1.1991746. [DOI] [PubMed] [Google Scholar]
8.Ajis A., Seybold J.D., Myerson M.S. Osteochondral distal metatarsal allograft reconstruction: A case series and surgical technique. Foot Ankle Int. 2013;34:1158–1167. doi: 10.1177/1071100713483118. [DOI] [PubMed] [Google Scholar]
9.Barlett D.H. Arthroscopic management of osteochondritis dissecans of the first metatarsal head. Arthroscopy. 1988;4:51–54. doi: 10.1016/s0749-8063(88)80014-8. [DOI] [PubMed] [Google Scholar]
10.Maresca G., Adriani E., Falez F., Mariani P.P. Arthroscopic treatment of bilateral Freiberg's infraction. Arthroscopy. 1996;12:103–108. doi: 10.1016/s0749-8063(96)90229-7. [DOI] [PubMed] [Google Scholar]
11.Hayashi K., Ochi M., Uchio Y., Takao M., Kaeasaki K., Yamagami N. A new surgical technique for treating bilateral Freiberg disease. Arthroscopy. 2002;18:660–664. doi: 10.1053/jars.2002.32865. [DOI] [PubMed] [Google Scholar]
12.Carro L.P., Golano P., Farinas O., Cerezal L., Abad J. Arthroscopic Keller technique for Freiberg disease. Arthroscopy. 2004;20:60–63. doi: 10.1016/j.arthro.2004.04.044. [DOI] [PubMed] [Google Scholar]
13.Lui T.H. Arthroscopic interpositional arthroplasty for Freiberg's disease. Knee Surg Sports Traumatol Arthrosc. 2007;15:555–559. doi: 10.1007/s00167-006-0189-4. [DOI] [PubMed] [Google Scholar]
14.Haleem A.M., Mintz D.N., Rozbruch S.R. Metatarsophalangeal arthritis following fourth metatarsal lengthening treated with distraction arthroplasty: Case report. Foot Ankle Int. 2014;35:1075–1081. doi: 10.1177/1071100714543648. [DOI] [PubMed] [Google Scholar]
15.Xie X., Shi Z., Gu W. Late-stage Freiberg's disease treated with dorsal wedge osteotomy and joint distraction arthroplasty: Technique tip. Foot Ankle Int. 2012;33:1015–1017. doi: 10.3113/FAI.2012.1015. [DOI] [PubMed] [Google Scholar]
16.Miyamoto W., Takao M., Innami K., Yasui Y., Matsushita T. Technique tip: Interposition of extensor digitorum longus after resection arthroplasty of lesser metatarsophalangeal joints for rheumatoid forefoot deformity. Foot Ankle Int. 2011;32:211–214. doi: 10.3113/FAI.2011.0211. [DOI] [PubMed] [Google Scholar]
17.Wen J.M., Sun W.D., Sang Z.C. Swanson double-stem silicone implant arthroplasty in the treatment of Freiberg disease. Zhongguo Gu Shang. 2009;22:423–425. [PubMed] [Google Scholar]
18.Lee E.J., Wong Y.S. Modification of lesser metatarsophalangeal joint arthroplasty using flexor digitorum longus transfer. Foot Ankle Spec. 2008;1:85–87. doi: 10.1177/1938640008315348. [DOI] [PubMed] [Google Scholar]
19.Enriquez Castro J.A., Guevara Hernandez G., Estevez Diaz G. Interposition arthroplasty as treatment of osteochondritis of the second metatarsal head. A case report. Acta Ortop Mex. 2008;22:259–262. [PubMed] [Google Scholar]
20.Ozkan Y., Ozturk A., Ozdemir R., Aykut S., Yalcin N. Interpositional arthroplasty with extensor digitorum brevis tendon in Freiberg's disease: A new surgical technique. Foot Ankle Int. 2008;29:488–492. doi: 10.3113/FAI-2008-0488. [DOI] [PubMed] [Google Scholar]
21.Capar B., Kutluay E., Mujde S. Dorsal closing-wedge osteotomy in the treatment of Freiberg's disease. Acta Orthop Traumatol Turc. 2007;41:136–139. [PubMed] [Google Scholar]
22.Kilic A., Cepni K.S., Aybar A., Polat H., May C., Parmaksizoglu A.S. A comperative study between two different surgical techniques in the treatment of late-stage Freiberg's disease. Foot Ankle Surg. 2013;19:234–238. doi: 10.1016/j.fas.2013.06.004. [DOI] [PubMed] [Google Scholar]
23.Liao C.Y., Lin A.C., Lin C.Y., Chao T.K., Lu T.C., Lee H.M. Interpositional arthroplasty with palmaris longus tendon graft for osteonecrosis of the second metatarsal head: A case report. J Foot Ankle Surg. 2015;54:237–241. doi: 10.1053/j.jfas.2014.12.003. [DOI] [PubMed] [Google Scholar]
24.Pastides P.S., El-Sallakh S., Charalambides C. Debridement and microfracture in the treatment of Freiberg disease. Tech Foot Ankle Surg. 2012;11:150–154. [Google Scholar]
25.Viladot A., Sr., Viladot A., Jr. Osteochondroses: Aseptic necrosis of the foot. In: Jahss M.H., editor. Ed 2. Vol III. WB Saunders; Philadelphia: 1991. pp. 617–638. (Disorders of the foot and ankle). [Google Scholar]
26.el-Tayeby H.M. Freiberg's infraction: A new surgical procedure. J Foot Ankle Surg. 1998;37:23–27. doi: 10.1016/s1067-2516(98)80007-0. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Video 1

Download video file^{(14MB, mp4)}

[bib1] 1.Freiberg A.H. Infraction of the second metatarsal bone. Surg Gynecol Obstet. 1914;19:191–193. [Google Scholar]

[bib2] 2.Smillie I.S. Treatment of Freiberg's infraction. Proc R Soc Med. 1967;60:29–31. doi: 10.1177/003591576706000117. [DOI] [PMC free article] [PubMed] [Google Scholar]

[bib3] 3.Trott A.W. Developmental disorders. In: Jahss M.H., editor. Ed 2. Vol III. WB Saunders; Philadelphia: 1991. pp. 607–616. (Disorders of the foot and ankle). [Google Scholar]

[bib4] 4.Talusan P.G., Diaz-Collado P.J., Reach J.S., Jr. Freiberg's infraction: Diagnosis and treatment. Foot Ankle Spec. 2014;7:52–56. doi: 10.1177/1938640013510314. [DOI] [PubMed] [Google Scholar]

[bib5] 5.Helal B., Gibb P. Freiberg's disease: A suggested pattern of management. Foot Ankle. 1987;8:94–99. doi: 10.1177/107110078700800205. [DOI] [PubMed] [Google Scholar]

[bib6] 6.Gauthier G., Elbaz R. Freiberg's infraction: A subchondral bone fatigue fracture. Clin Orthop Relat Res. 1979;(142):93–95. [PubMed] [Google Scholar]

[bib7] 7.Smith T.W.D., Stanley D., Rowley D.I. Treatment of Freiberg's disease. A new operative technique. J Bone Joint Surg Br. 1991;73:129–130. doi: 10.1302/0301-620X.73B1.1991746. [DOI] [PubMed] [Google Scholar]

[bib8] 8.Ajis A., Seybold J.D., Myerson M.S. Osteochondral distal metatarsal allograft reconstruction: A case series and surgical technique. Foot Ankle Int. 2013;34:1158–1167. doi: 10.1177/1071100713483118. [DOI] [PubMed] [Google Scholar]

[bib9] 9.Barlett D.H. Arthroscopic management of osteochondritis dissecans of the first metatarsal head. Arthroscopy. 1988;4:51–54. doi: 10.1016/s0749-8063(88)80014-8. [DOI] [PubMed] [Google Scholar]

[bib10] 10.Maresca G., Adriani E., Falez F., Mariani P.P. Arthroscopic treatment of bilateral Freiberg's infraction. Arthroscopy. 1996;12:103–108. doi: 10.1016/s0749-8063(96)90229-7. [DOI] [PubMed] [Google Scholar]

[bib11] 11.Hayashi K., Ochi M., Uchio Y., Takao M., Kaeasaki K., Yamagami N. A new surgical technique for treating bilateral Freiberg disease. Arthroscopy. 2002;18:660–664. doi: 10.1053/jars.2002.32865. [DOI] [PubMed] [Google Scholar]

[bib12] 12.Carro L.P., Golano P., Farinas O., Cerezal L., Abad J. Arthroscopic Keller technique for Freiberg disease. Arthroscopy. 2004;20:60–63. doi: 10.1016/j.arthro.2004.04.044. [DOI] [PubMed] [Google Scholar]

[bib13] 13.Lui T.H. Arthroscopic interpositional arthroplasty for Freiberg's disease. Knee Surg Sports Traumatol Arthrosc. 2007;15:555–559. doi: 10.1007/s00167-006-0189-4. [DOI] [PubMed] [Google Scholar]

[bib14] 14.Haleem A.M., Mintz D.N., Rozbruch S.R. Metatarsophalangeal arthritis following fourth metatarsal lengthening treated with distraction arthroplasty: Case report. Foot Ankle Int. 2014;35:1075–1081. doi: 10.1177/1071100714543648. [DOI] [PubMed] [Google Scholar]

[bib15] 15.Xie X., Shi Z., Gu W. Late-stage Freiberg's disease treated with dorsal wedge osteotomy and joint distraction arthroplasty: Technique tip. Foot Ankle Int. 2012;33:1015–1017. doi: 10.3113/FAI.2012.1015. [DOI] [PubMed] [Google Scholar]

[bib16] 16.Miyamoto W., Takao M., Innami K., Yasui Y., Matsushita T. Technique tip: Interposition of extensor digitorum longus after resection arthroplasty of lesser metatarsophalangeal joints for rheumatoid forefoot deformity. Foot Ankle Int. 2011;32:211–214. doi: 10.3113/FAI.2011.0211. [DOI] [PubMed] [Google Scholar]

[bib17] 17.Wen J.M., Sun W.D., Sang Z.C. Swanson double-stem silicone implant arthroplasty in the treatment of Freiberg disease. Zhongguo Gu Shang. 2009;22:423–425. [PubMed] [Google Scholar]

[bib18] 18.Lee E.J., Wong Y.S. Modification of lesser metatarsophalangeal joint arthroplasty using flexor digitorum longus transfer. Foot Ankle Spec. 2008;1:85–87. doi: 10.1177/1938640008315348. [DOI] [PubMed] [Google Scholar]

[bib19] 19.Enriquez Castro J.A., Guevara Hernandez G., Estevez Diaz G. Interposition arthroplasty as treatment of osteochondritis of the second metatarsal head. A case report. Acta Ortop Mex. 2008;22:259–262. [PubMed] [Google Scholar]

[bib20] 20.Ozkan Y., Ozturk A., Ozdemir R., Aykut S., Yalcin N. Interpositional arthroplasty with extensor digitorum brevis tendon in Freiberg's disease: A new surgical technique. Foot Ankle Int. 2008;29:488–492. doi: 10.3113/FAI-2008-0488. [DOI] [PubMed] [Google Scholar]

[bib21] 21.Capar B., Kutluay E., Mujde S. Dorsal closing-wedge osteotomy in the treatment of Freiberg's disease. Acta Orthop Traumatol Turc. 2007;41:136–139. [PubMed] [Google Scholar]

[bib22] 22.Kilic A., Cepni K.S., Aybar A., Polat H., May C., Parmaksizoglu A.S. A comperative study between two different surgical techniques in the treatment of late-stage Freiberg's disease. Foot Ankle Surg. 2013;19:234–238. doi: 10.1016/j.fas.2013.06.004. [DOI] [PubMed] [Google Scholar]

[bib23] 23.Liao C.Y., Lin A.C., Lin C.Y., Chao T.K., Lu T.C., Lee H.M. Interpositional arthroplasty with palmaris longus tendon graft for osteonecrosis of the second metatarsal head: A case report. J Foot Ankle Surg. 2015;54:237–241. doi: 10.1053/j.jfas.2014.12.003. [DOI] [PubMed] [Google Scholar]

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PERMALINK

Arthroscopic Interpositional Arthroplasty of the Second Metatarsophalangeal Joint

Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S.

Abstract

Table 1.

Technique