Tendon arthroplasty for basal fourth and fifth metatarsal arthritis.
ABSTRACT Arthritis of the fourth and fifth tarsometatarsal joints, recalcitrant to nonoperative treatment, presents a difficult clinical situation. As part of the lateral rays, these joints have considerable motion, making fusion a very disabling operation. Between 1990 and 1998, 12 patients, who had failed nonoperative treatment, underwent resection arthroplasty of the base of the fifth or fourth and fifth metatarsals with tendon interposition. Preoperative differential injections had confirmed the source of pain in eight cases. Patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale; a visual analogue scale to assess perception of pain and disability; a satisfaction index; and, where possible, a comprehensive physical examination. At an average of 25 months follow-up, the average AOFAS score was 64.5. On the visual analogue scale, pain improved an average of 35% and disability improved 10%. Six of the eight patients who participated in this study were satisfied with the operation and would undergo the procedure again for similar symptoms. Patients with a higher postoperative score on the AOFAS midfoot rating scale were statistically more likely to have had a positive differential injection preoperatively. We believe a lateral column tarsometatarsal resection arthroplasty is an effective salvage operation when lateral column midfoot arthritis is confirmed by differential injection and nonoperative measures have provided inadequate relief.
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ABSTRACT: We describe an arthroscopic approach of tarsometatarsal arthrodesis for post-traumatic arthritis. Five tarsometatarsal portals (medial, P1-2, P2-3, P3-4, P4-5) are identified at the junctional points between the metatarsals by means of image intensifier. The first metatarsocuneiform joint is approached through the medial and P1-2 portal. Articular cartilage is denuded and micro-fracture of subchondral bone is performed with an arthroscopic awl. The second metatarsocuneiform joint is approached through the P1-2 and P2-3 portals and the third metatarsocuneiform joint is approached through the P2-3 and P3-4 portals. The articular surfaces are prepared for arthrodesis. The articulations are kept in desired position and transfixed with 4.0 mm cannulated screws. The fourth and fifth metatarsocuboid articulations are rarely included in the procedure. Arthroscopic arthrodesis or tendon arthroplasty of the lateral column can be performed through the P3-4 and P4-5 portals.Knee Surgery Sports Traumatology Arthroscopy 06/2007; 15(5):671-5. · 2.68 Impact Factor