Tran Aaron, Enright Brennan, Reichenbach Rachel, Henderson Jordan, Jaffe David
Department of Orthopaedics, University of San Diego School of Medicine, La Jolla, CA, USA.
University of Utah School of Medicine, Salt Lake City, UT, USA.
Foot Ankle Orthop. 2025 Jun 16;10(2):24730114251343071. doi: 10.1177/24730114251343071. eCollection 2025 Apr.
Arthrodesis of the first metatarsophalangeal (MTP) joint is a well-established procedure with excellent outcomes for patients with forefoot disorders. Routine bone grafting is not typically required, but bone graft may be necessary in the setting of revision surgery. Because of potential harvesting morbidity and time associated with an extra incision, allograft bone is frequently used. In this study, we describe the outcomes of an approach to first MTP fusion with simultaneous medial sesamoidectomy for utilization as autograft.
A retrospective review of all first MTP arthrodesis cases performed by one fellowship-trained foot and ankle surgeon were identified. Operative reports and radiographs were reviewed identifying patients who underwent simultaneous medial sesamoidectomy for autograft purposes. Indications for sesamoidectomy harvesting were noted. The primary outcome reviewed was fusion rate. Overall nonunion rates and patient outcomes were collected and compared between those undergoing sesamoidectomy for grafting and those undergoing standard procedure arthrodesis.
A total of 107 patients underwent first MTP arthrodesis. Of these, 24 underwent concurrent sesamoidectomy grafting with 9 requiring additional calcaneal grafting. Indications for the sesamoidectomy group included 5 primary cases of erosive hallux rigidus, 2 cases of hallux valgus, 6 nonunions, 3 failed Cartiva implants, 2 cases of avascular necrosis, 4 failed arthroplasties, and 2 conversion bunionectomy. All 24 patients in the sesamoidectomy group achieved successful union. For context, the broader cohort undergoing first MTP arthrodesis had a fusion rate of 92.1%. All patients in the sesamoidectomy group were satisfied with their surgical outcome.
This study found highly successful fusion rates in a potentially higher risk population with the use of local autografting from the medial sesamoid. The medial sesamoid serves as a freely available, structurally supportive graft material for first MTP arthrodesis that can be readily harvested via the same incision, potentially reducing the need for additional graft sites. However, given the retrospective nature, single-surgeon cohort, and small sample size, further studies are warranted to confirm these findings and evaluate comparative outcomes.
Level III, retrospective comparative study.
第一跖趾（MTP）关节融合术是一种成熟的手术方法，对于前足疾病患者有出色的治疗效果。通常不需要常规植骨，但翻修手术时可能需要植骨。由于取自体骨存在潜在的并发症及额外切口所需的时间，同种异体骨常被使用。在本研究中，我们描述了一种第一跖趾关节融合同时行内侧籽骨切除术作为自体骨移植的方法的治疗效果。
对一位接受过足踝专科培训的外科医生所做的所有第一跖趾关节融合术病例进行回顾性分析。查阅手术记录和X线片，确定因自体骨移植目的而行同期内侧籽骨切除术的患者。记录籽骨切除取材的适应证。主要观察指标为融合率。收集并比较接受籽骨切除植骨术患者与接受标准关节融合术患者的总体不愈合率及患者治疗效果。
共有107例患者接受了第一跖趾关节融合术。其中，24例同时行籽骨切除植骨术，9例需要额外取自跟骨植骨。籽骨切除组的适应证包括5例原发性侵蚀性拇僵硬、2例拇外翻、6例不愈合、3例Cartiva植入失败、2例缺血性坏死、4例关节成形术失败以及2例拇囊炎切除术翻修。籽骨切除组的所有24例患者均成功融合。作为对照，接受第一跖趾关节融合术的更广泛队列的融合率为92.1%。籽骨切除组的所有患者对手术效果均满意。
本研究发现，在潜在高风险人群中，使用内侧籽骨进行局部自体骨移植获得了很高的融合率。内侧籽骨可作为一种可随时获取、结构上有支撑作用的移植材料用于第一跖趾关节融合术，且可通过同一切口轻松取材，有可能减少对额外取材部位的需求。然而，鉴于本研究的回顾性性质、单外科医生队列及小样本量，需要进一步研究来证实这些发现并评估对比结果。
III级，回顾性对比研究。
