Fellowship Director, Orthopaedic Institute of Central Jersey, Manasquan, NJ.
Past Fellow, Foot and Ankle Surgeon, Northwest Kaiser Permanente, Portland, OR.
J Foot Ankle Surg. 2021 Jan-Feb;60(1):157-162. doi: 10.1053/j.jfas.2020.04.003. Epub 2020 Nov 5.
Osteochondral fresh allograft transfer of the first metatarsal can be an accepted surgical management option for early stages of hallux limitus. This study consisted of evaluating clinical outcomes with patients who underwent this procedure. Thirteen (N=13) patients were included in this study, 10 (76.9%) were female and 3 (23.1%) were male. The mean age was 52.2 (range, 27-61) years and the mean body mass index was 25.3 (range, 33.8-19.4) kg/m. Intraoperative evaluation of osteochondral defects of the first metatarsal demonstrated a mean diameter size of 8.2 mm. Ten (76.9%) patients had a concomitant cheilectomy procedure performed. The mean follow-up was 41.0 (range, 3.5-89.1) months. American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale questionnaire and patient satisfaction survey were completed. The mean AOFAS Hallux Metatarsophalangeal-Interphalangeal score, which was determined postoperatively, was 71.2 (range, 55-85) of 100. Four (30.8%) patients with overall scores below 60 (range, 55-59) reported moderate daily pain at the first metatarsophalangeal joint. Mean AOFAS pain score was 26.9 (range, 20-30) of 40. Mean AOFAS function score was 30.8 (range, 24-35) of 45. Mean AOFAS alignment score was 13.4 (range, 8-15) of 15. There was statistical significance in mean AOFAS total score when comparing hallux limitus grade 1 versus grade 2, as well as when comparing grade 1 versus grade 3, p < .05. There was no significance in mean AOFAS total score when comparing number of plugs used, body mass index, and size of defect. However, an overall improvement in preoperative symptoms and patient satisfaction was documented and therefore osteochondral fresh allograft transfer can be considered a reasonable option in treating defects found at the first metatarsal head.
第一跖骨的新鲜同种异体软骨移植可作为治疗早期跖趾关节僵硬的一种可接受的手术治疗选择。本研究评估了接受该手术的患者的临床结果。本研究共纳入 13 例（N=13）患者，其中 10 例（76.9%）为女性，3 例（23.1%）为男性。平均年龄为 52.2（范围 27-61）岁，平均体重指数为 25.3（范围 33.8-19.4）kg/m2。第一跖骨的软骨骨缺损的术中评估显示平均直径为 8.2mm。10 例（76.9%）患者同时行跖骨头切除术。平均随访时间为 41.0（范围 3.5-89.1）个月。完成了美国矫形足踝协会（AOFAS）大脚趾跖趾-趾间关节量表问卷和患者满意度调查。术后确定的平均 AOFAS 大脚趾跖趾-趾间关节评分（100 分制）为 71.2（范围 55-85）。4 例（30.8%）总分低于 60（范围 55-59）的患者报告第一跖趾关节有中度日常疼痛。平均 AOFAS 疼痛评分为 40 分中的 26.9（范围 20-30）。平均 AOFAS 功能评分为 45 分中的 30.8（范围 24-35）。平均 AOFAS 对线评分 15 分中的 13.4（范围 8-15）。在比较跖趾关节僵硬 1 级与 2 级以及 1 级与 3 级时，AOFAS 总分的平均值具有统计学意义，p<.05。当比较使用的移植物数量、体重指数和缺损大小时，AOFAS 总分的平均值没有统计学意义。然而，术前症状和患者满意度均有整体改善，因此，新鲜同种异体软骨移植可被视为治疗第一跖骨头缺损的合理选择。
