Arcângelo Joana, Silva Eduardo Ramalho, Norte Susana, Sant'anna Francisco, Thüsing Monika, Neves Manuel Cassiano
Department of Pediatric Orthopedic Surgery, CUF Descobertas Hospital, Lisbon, Portugal.
Department of Orthopedic Surgery, Hospital Ortopédico San'Iago do Outão, Setúbal, Portugal.
J Orthop Case Rep. 2023 Jul;13(7):20-26. doi: 10.13107/jocr.2023.v13.i07.3740.
First metatarsophalangeal (MTP) joint mobility is critical to a normal gait pattern; therefore, osteochondral defects (OCDs) of the first metatarsal head should be treated promptly to avoid functional limitation and progression to hallux rigidus. <15 cases of OCDs of the first MTP joint in the pediatric population, predominantly adolescents, have been published so far. The purpose of this article is to present a rare case of an adolescent first MTP joint OCD treated by the technique of autograft osteochondral mosaicplasty, which has been commonly used for OCDs of the knee and talus but scarcely described for the first MTP joint.
The case of a 13-year-old male futsal player with a post-traumatic 50 mm2 OCD of the first metatarsal head is presented. The Osteochondral Autograft Transfer System® (Arthrex Inc™, Naples, FL) was used to harvest a 10-mm diameter donor plug from the medial ipsilateral femoral condyle, then delivered to the first metatarsal head. At the 6-month follow-up, physical activity had been resumed with no pain or significant mobility limitation and an improvement of the American Orthopedic Foot and Ankle Society hallux score of 54-95 points. At the same time, a follow-up magnetic resonance showed complete incorporation of the osteochondral graft without bone edema or subchondral osteonecrosis.
Treatment for osteochondral lesions, regardless of their location, aims to restore function by recreating the articular congruity reducing the potential for a progressive degenerative process. Multiple surgical treatment options exist for OCDs of the first metatarsal head. The treatment decision must take into consideration both patient factors and lesion factors. Based on this, a literature revision and treatment decision rationale are presented. This case demonstrated that an osteochondral transplant could be a reasonable treatment option for a traumatic, full-thickness OCD of the first metatarsal head in adolescent patients.
第一跖趾关节（MTP）的活动度对正常步态模式至关重要；因此，第一跖骨头的骨软骨缺损（OCD）应及时治疗，以避免功能受限和发展为僵硬拇趾。迄今为止，已发表了不到15例儿科人群（主要是青少年）第一跖趾关节OCD的病例。本文的目的是介绍一例罕见的青少年第一跖趾关节OCD病例，该病例采用自体骨软骨镶嵌成形术进行治疗，该技术常用于膝关节和距骨的OCD，但很少用于第一跖趾关节。
介绍了一名13岁男性五人制足球运动员的病例，其第一跖骨头有创伤后50平方毫米的OCD。使用骨软骨自体移植系统（Arthrex Inc™，那不勒斯，佛罗里达州）从同侧内侧股骨髁采集直径为10毫米的供体骨栓，然后将其植入第一跖骨头。在6个月的随访中，患者已恢复体育活动，无疼痛或明显活动受限，美国矫形足踝协会拇趾评分从54分提高到95分。同时，随访磁共振显示骨软骨移植完全融合，无骨水肿或软骨下骨坏死。
无论骨软骨损伤位于何处，其治疗目的都是通过重建关节一致性来恢复功能，减少进行性退变过程的可能性。第一跖骨头OCD有多种手术治疗选择。治疗决策必须考虑患者因素和损伤因素。基于此，本文进行了文献综述并阐述了治疗决策依据。该病例表明，骨软骨移植可能是青少年患者第一跖骨头创伤性全层OCD的一种合理治疗选择。
