Advertisement

Arthroscopy of the First Metatarsophalangeal Joint

  • Kenichiro Nakajima
    Correspondence
    Address correspondence to:Department of Orthopaedic Surgery, Yashio Central General Hospital, 845 Minamikawasaki, Yashio-shi, Saitama 340-0814, Japan.
    Affiliations
    Orthopedic Surgeon, Department of Orthopaedic Surgery, Yashio Central General Hospital, Saitama, Japan
    Search for articles by this author

      Abstract

      Arthroscopic treatments for the first metatarsophalangeal joint have not spread fully owing to a number of factors. First, in the common arthroscopic view, the joint is observed from above, which makes the structures difficult to grasp and the dorsal aspect of the joint difficult to visualize and treat. Second, techniques for widening the view have not yet been reported. Third, the portals necessary for observation and treatment with hallux sesamoids have not yet been established. Finally, techniques for detecting the sesamoids have not been previously reported. We have developed a method for first metatarsophalangeal joint arthroscopy by treating 14 patients with hallux rigidus and 9 patients with hallux sesamoid disorders. We report a new method that combines a variety of arthroscopic techniques. Our study has 4 novel points. First, in our arthroscopic technique, the joint can be examined from the medial side because traction is directly and horizontally applied to the great toe using an adjustable traction device with the surgeon standing on the unoperated side. The technique enables observation of the dorsal aspect of the metatarsal head and proximal phalanx and makes the structures easier to grasp. Second, the coagulator technique as an arthroscopic aid is demonstrated. Third, all aspects of the joint, including the sesamoids, can be observed through our 4 portals. Finally, techniques for detecting the sesamoids are identified. We believe our novel method will ensure that arthroscopy of the first metatarsophalangeal joint is easier than previously described methods.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Watanabe M.
        Selfoc®-arthroscope.
        (In 1972 Monograph, edited by Teishin Hospital, Tokyo, pp 1-12)1972
        • Ferkel R.D.
        Great-toe arthroscopy.
        in: Ferkel R.D. Arthroscopic Surgery: The Foot and Ankle. Lippincott-Raven, Philadelphia1996: 255-272
        • Davis M.S.
        • Saxby T.S.
        Arthroscopy of the first metatarsophalangeal joint.
        J Bone Joint Surg Br. 1999; 81B: 203-206
        • Frey C.
        • van Dijk C.N.
        Arthroscopy of the great toe.
        AAOS Instr Course Lect. 1999; 48: 343-346
        • Davies M.S.
        • Saxby T.S.
        Arthroscopy of the hallux metatarsophalangeal joint.
        Foot Ankle Clin. 2000; 5: 715-724
        • Frey C.
        • van Dijk C.N.
        Arthroscopy of the great toe.
        in: Chow J.C.Y. Advanced Arthroscopy. Springer-Verlag, New York2001: 675-682
        • Siclari A.
        • Piras M.
        Hallux metatarsophalangeal arthroscopy: indication and techniques.
        Foot Ankle Clin. 2015; 20: 109-122
        • Hunt K.J.
        Hallux metatarsophalangeal (MTP) joint arthroscopy for hallux rigidus.
        Foot Ankle Int. 2015; 36: 113-119
        • Bartlett D.H.
        Arthroscopic management of osteochondritis dissecans of the first metatarsal head.
        Arthroscopy. 1988; 4: 51-54
        • Bojanic I.
        • Smoljanovic T.
        • Kubat O.
        Osteochondritis dissecans of the first metatarsophalangeal joint: arthroscopy and microfracture technique.
        J Foot Ankle Surg. 2011; 50: 623-625
        • Borton D.C.
        • Peereboom J.
        • Saxby T.S.
        Foot Ankle Int. 1997; 18: 504-505
        • Iqbal M.J.
        • Chana G.S.
        Arthroscopic cheilectomy for hallux rigidus.
        Arthroscopy. 1998; 14: 307-310
        • Carro L.P.
        • Vallina B.B.
        Arthroscopic-assisted first metatarsophalangeal joint arthrodesis.
        Arthroscopy. 1999; 15: 215-217
        • Carro L.P.
        • Llata J.I.E.
        • Agueros J.A.M.
        Arthroscopic medial bipartite sesamoidectomy of the great toe.
        Arthroscopy. 1999; 15: 321-323
        • Chan P.K.
        • Lui T.H.
        Arthroscopic fibular sesamoidectomy in the management of the sesamoid osteomyelitis.
        Knee Surg Sports Traumatol Arthrosc. 2006; 14: 664-667
        • Nishikawa S.
        • Toh S.
        Arthroscopic treatment of a ganglion of the first metatarsophalangeal joint.
        Arthroscopy. 2004; 20: 69-72
        • Lui T.H.
        Arthroscopic release of first metatarsophalangeal arthrofibrosis.
        Arthroscopy. 2006; 22: 906.e1-906.e4
        • Debnath U.K.
        • Hemmady M.V.
        • Hariharan K.
        Indication for and technique of first metatarsophalangeal joint arthroscopy.
        Foot Ankle Int. 2006; 27: 1049-1054
        • Lui T.H.
        Endoscopic resection of the gouty tophi of the first metatarsophalangeal joint.
        Arch Orthop Trauma Surg. 2008; 128: 521-523
        • Wang C.C.
        • Lien S.B.
        • Huang G.S.
        • Pan R.Y.
        • Shen H.C.
        • Kuo C.L.
        • Shen P.H.
        • Lee C.H.
        Arthroscopic elimination of monosodium urate deposition of the first metatarsophalangeal joint reduces the recurrence of gout.
        Arthroscopy. 2009; 25: 153-158
        • Lui T.H.
        First metatarsophalangeal joint arthroscopy in patients with hallux valgus.
        Arthroscopy. 2008; 24: 1122-1129
        • Siclari A.
        • Decantis V.
        Arthroscopic lateral release and percutaneous distal osteotomy for hallux valgus: a preliminary report.
        Foot Ankle Int. 2009; 30: 675-679
        • Ahn J.H.
        • Choy W.S.
        • Lee K.W.
        Arthroscopy of the first metatarsophalangeal joint in 59 consecutive cases.
        Foot Ankle Surg. 2012; 51: 161-167
        • Lui T.H.
        First metatarsophalangeal arthroscopy in patients with post-traumatic hallux valgus.
        Foot (Edinb). 2015; 25: 270-276
        • Lui T.H.
        Arthroscopic first metatarsophalangeal arthrodesis for repair of fixed hallux varus deformity.
        Foot Ankle Surg. 2015; 54: 1127-1131
        • Lundeen R.O.
        Arthroscopic approaches to the joint of the foot.
        J Am Podiatr Med Assoc. 1987; 77: 451-455
        • Jaivin J.S.
        • Ferkel R.D.
        Arthroscopy of the foot and ankle.
        Clin Sports Med. 1994; 13: 761-783
        • Dijk C.N.
        • Veenstra K.M.
        • Nuwsch B.C.
        Arthroscopic surgery of the metatarsophalangeal first joint.
        Arthroscopy. 1998; 14: 851-855
        • Shonka T.E.
        Metatarsal phalangeal joint arthroscopy.
        Foot Ankle Surg. 1991; 30: 26-28
        • Derner R.
        • Naldo J.
        Small joint arthroscopy of the foot.
        Clin Podiatr Med Surg. 2011; 28: 551-560
        • Vaseenon T.
        • Phisitkul P.
        Arthroscopic debridement for first metatarsophalangeal joint arthrodesis with a 2- versus 3-portal technique: a cadaveric study.
        Arthroscopy. 2010; 26: 1363-1367