Osteochondral Fresh Allograft Transfer to Address Osteochondral Defect of the First Metatarsal Head in Early Hallux Limitus
Purpose: To describe the use of fresh osteochondral allografts (OCAs) for the treatment of early-stage hallux limitus in the first metatarsophalangeal joint.
- Hallux limitus is the term for degenerative arthritis of the first metatarsophalangeal joint.
- The surgical technique used replaces the defect with fresh allograft bone and a hyaline cartilage cap rather than fibrocartilage.
- Fresh donor grafts used were the first metatarsal, talus, and femoral condyles.
- 13 patients underwent surgical treatment with an OCA. Mean graft diameter was 8.2mm.
- 9 patients had a single OCA plug transferred and the other 4 patients required two plugs.
- There was minimal difference in outcomes. Patients with a single plug had a mean AOFAS score of 71 while patients with two had a mean score of 71.5.
- Rehab consisted of immediate weight bearing with the protection of a short pneumatic walking boot.
- Range of motion exercises to the first metatarsophalangeal joint were initiated at the first post-operative visit.
- With a mean follow-up of 41.0 months, all 13 patients reported improvements from their preoperative conditions and symptoms.
- 8 patients (61.5%) were “very satisfied” with the procedure and the remaining 5 (38.5%) were “satisfied”.
Take-Away: OCAs are a reasonable option in treating defects of the first metatarsal head as they restore joint functionality while also maintaining the overall anatomy. The ability to use fresh OCAs expands the options available to address patients with osteochondral defects of the first metatarsal head.
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Shane Hollawell, DPM, FACFAS, Ruth Moen, DPM, AACFAS, Meagan Coleman, DPM, AACFAS, Michael Carson, MD. "Osteochondral Fresh Allograft Transfer to Address Osteochondral Defect of the First Metatarsal Head in Early Hallux Limitus". Journal of Foot & Ankle Surgery. November 04, 2020.