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Hallux limitus/rigidus dermal grafting results in good function, minor complications
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MONTREAL — A less aggressive combined treatment for hallux limitus/rigidus appeared to lead to fewer complications and minimal bone loss while restoring function, according to a presentation at the International Cartilage Repair Society World Congress 2012.
Luis J. Sanchez, MD, noted that arthrodesis may be the “gold standard” for operative treatment of hallux limitus/rigidus, but alternatives exist, including his dermal graft-based approach, which is less aggressive. He said it yields improved initial outcomes and fewer postoperative complications.
“This approach has been done in the past by at least a few other authors in the literature,” Sanchez said. “I have modified the technique to, I think, improve the final results.”
Luis J. Sanchez
Sanchez noted that on radiographs it is possible to miss significant aspects of the true joint pathology and those aspects only become apparent when the operation begins, he said.
“The radiographic classifications we have truly do not go along with the true pathology of this disorder,” he said. “They don't.”
The combination of treatments Sanchez discussed involved first metatarsal distal decompression osteotomy, cheilectomy of the joint, full release of the fibrotic or contracted tissue surrounding the joint and plantar sesamoids, and the addition of a dermal, allogenic scaffold graft to cover the first metatarsal head.
According to the study abstract, the operations were performed between January 2009 and January 2011 in 22 patients aged 34 years to 70 years old, with a mean average age of 54 years. All 22 patients postoperatively asserted they would undergo the surgery again and could undergo full protected walking in a surgical shoe within 3 weeks of the procedure, as noted in the abstract.
Furthermore, Sanchez said there have been no revisions to date and only three minor complications, which involved two wound closure necrosis issues resolved through office wound care, and one cellulitis or skin infection case treated with antibiotics.
Reference:
- Sanchez, LJ. Dermal graft application in hallux limitus/rigidus for salvage of the 1st metatarsophallangeal joint. Paper #8.1.3. Presented at the International Cartilage Repair Society World Congress 2012. May 12-15. Montreal.