Osteochondral autologous transplantation found efficacious for Freiberg infraction
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Compared with dorsiflexion closing wedge metatarsal osteotomy, investigators found osteochondral autologous transplantation was safe and effective for the treatment of Freiberg infraction in an athletic population.
Researchers identified 27 consecutive patients with Freiberg infraction. Fourteen patients were randomly assigned to undergo dorsiflexion closing wedge metatarsal osteotomy and 13 patients were randomized to osteochondral autologous transplantation. The mean follow-up was 46 months. Postoperative complications, range of motion of the metatarsophalangeal joint, length of the metatarsal, function of the foot and pain were the primary outcomes.
Results showed the mean standard deviation American Orthopaedic Foot and Ankle Society-lesser metatarsophalangeal-interphalangeal score (AOFAS-LMI) for patients who underwent dorsiflexion closing wedge metatarsal osteotomy was 63.4 preoperatively, was 81.8 at 1 year postoperatively and was 84.4 at 3 years postoperatively. The AOFAS-LMI score preoperatively, at 1 year postoperatively and at 3 years postoperatively for patients who underwent osteochondral autologous transplantation was 62.8, 89.9 and 92.6, respectively. Investigators noted that at 1 year and 3 years postoperatively, the differences in the AOFAS-LMI scores favored patients who underwent osteochondral autologous transplantation vs. dorsiflexion closing wedge metatarsal osteotomy, but this finding was not clinically significant. Mean VAS foot and ankle score significantly improved in patients who underwent dorsiflexion closing wedge metatarsal osteotomy from 48.1 to 91.8 and improved from 49.9 to 95.4 in patients who underwent osteochondral autologous transplantation.
According to researchers, there was a mean shortening of 1.9 mm in the metatarsals of patients who underwent dorsiflexion closing wedge metatarsal osteotomy; however, patients who underwent osteochondral autologous transplantation had a metatarsal lengthening of 0.2 mm. Patients who underwent osteochondral autologous were able to begin training and return to full sport at 6 weeks and 10 weeks, respectively. Patients in the comparison group were able to achieve this at 8 weeks and 13 weeks, respectively. – by Monica Jaramillo
Disclosures: The authors report no relevant financial disclosures.
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