First metatarsophalangeal joint chondroplasty using the autologous matrix-induced chondrogenesis in treatment of patients with hallux rigidus. Analysis of immediate and medium-term results

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Abstract


Introduction. To date, there is no single approach to the surgical treatment of hallux rigidus. In turn, it is known that in the presence of bone-cartilaginous defects in knee, hip and ankle joints, the autologous matrix-induced chondrogenesis is quite successfully used. In this regard, we have proposed to use this technique in patients with hallux rigidus.

The aim of the study was to evaluate the clinical efficacy of the 1st MTP joint chondroplasty using the induced chondrogenesis technique in patients with HR, to analyze the immediate and medium-term results of the operations in terms of pain and function.

Materials and methods. The 1st MTP joint chondroplasty has been performed in 21 patients with hallux rigidus. Before the surgery the range of motion (ROM) in 1st MTP joint was measured; the foot condition was evaluated using such scales as VAS of pain, AOFAS, VAS FA. The 1st MTP joint chondroplasty was performed using the technique of the induced chondrogenesis with collagen matrix. The results of surgical treatment were evaluated within 3, 6 and 12 months after surgery.

Results: 3 months after the operation, a significant decrease in pain, an increase in ROM in 1st MTP joint and an improvement in the foot function were observed. Subsequently, a moderate positive dynamic was observed.

Conclusion: the results of the operations showed that the 1st MTP joint chondroplasty can be an effective method of surgical treatment, which allows to relieve pain and significantly improve the quality of life of patients with hallux rigidus, both young and elderly. Also, this technique can be used in the treatment of patients with rheumatic diseases of the low activity or remission.


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About the authors

Maxim R. Nurmukhametov

V.A. Nasonova Research Institute of Rheumatology

Author for correspondence.
Email: nurmi91@mail.ru
ORCID iD: 0000-0001-6847-6396

Russian Federation, Moscow

orthopedic surgeon

Maxim A. Makarov

V.A. Nasonova Research Institute of Rheumatology

Email: ortopedniir@mail.ru

Russian Federation, Moscow

PhD, Head of the rheumosurgery laboratory

Evgeny I. Bialik

V.A. Nasonova Research Institute of Rheumatology

Email: sklifbialik@yandex.ru

Russian Federation, Moscow

PhD, Professor, leading researcher of the rheumosurgery laboratory

Sergey A. Makarov

V.A. Nasonova Research Institute of Rheumatology

Email: smakarov59@rambler.ru

Russian Federation, Moscow

PhD, Head of the orthopedic surgery department

Yaroslav B. Khrennikov

Federal Scientific and Clinical Center of Specialized Types of Medical Care and Medical Technologies of the Federal Medical and Biological Agency of Russia

Email: yaroslav79@yandex.ru

Russian Federation, Moscow

PhD, orthopedic surgeon

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Supplementary files

Supplementary Files Action
1.
Fig. 1. Patient distribution according to the Coughlin-Shurnas classification

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2.
Fig. 2. Osteophytes on the 1st metatarsal bone head and the base of the proximal phalanx of the 1st toe

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3.
Fig. 3. Cheilectomy, removing of damaged cartilage

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4.
Fig. 4. Microfracturing of the defect area

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5.
Fig. 5. Placing and fixation of the collagen matrix

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6.
Fig. 6. Range of motion in the I metatarsophalangeal joint after wound closure

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7.
Fig. 7. Visual Analog scale of pain dynamics, mm

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8.
Fig. 8. American Orthopedic Foot & Ankle Society scale dynamic, score

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9.
Fig. 9. Visual Analogue Scale of Foot & Ankle dynamic, score

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10.
Fig. 10. Dynamics of the range of motion in 1st metatarsophalangeal joint

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11.
Fig. 11. X-ray of the foot before and the first day after the 1st and 2nd metatarsophalangeal joints chondroplasty

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12.
Fig. 12. Range of motion in 1st metatarsophalangeal joint 12 months after the surgery (patient E., 70 years)

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13.
Fig. 13. Foot MRI 12 months after the surgery (patient D., 40 years)

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Copyright (c) 2020 Nurmukhametov M.R., Makarov M.A., Bialik E.I., Makarov S.A., Khrennikov Y.B.

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