Outcomes following minimally invasive dorsal cheilectomy for hallux rigidus:A systematic review

BACKGROUND Cheilectomy of the 1^(st)metatarsophalangeal joint(MTPJ)is one of the most common procedures for the management of hallux rigidus.However,there is no consensus regarding outcomes following minimally invasive dorsal cheilectomy(MIDC)for the management of hallux rigidus.AIM To evaluate outcomes following MIDC for the management of hallux rigidus.METHODS During November 2023,the PubMed,EMBASE and Cochrane Library databases were systematically reviewed to identify clinical studies examining outcomes following MIDC for the management of hallux rigidus.RESULTS Six studies were included.In total,348 patients(370 feet)underwent MIDC for hallux rigidus at a weighted mean follow-up of 37.9±16.5 months.The distribution of patients by Coughlin and Shurna's classification was recorded in 4 studies as follows:Ⅰ(58 patients,27.1%),Ⅱ(112 patients,52.3%),Ⅲ(44 patients,20.6%).Three studies performed an additional 1^(st)MTPJ arthroscopy and debridement following MIDC.Retained intra-articular bone debris was observed in 100%of patients in 1 study.The weighted mean American orthopedic foot and ankle society score improved from a preoperative score of 68.9±3.2 to a postoperative score of 87.1.The complication rate was 8.4%,the most common of which was persistent joint pain and stiffness.Thirty-two failures(8.7%)were observed.Thirty-three secondary procedures(8.9%)were performed at a weighted mean time of 8.6±3.2 months following the index procedure.CONCLUSION This systematic review demonstrated improvements in subjective clinical outcomes together with a moderate complication rate following MIDC for the management of hallux rigidus at short-term follow-up.A moderate reoperation rate at short-term follow-up was recorded.The marked heterogeneity between included studies and paucity of high quality comparative studies limits the generation of any robust conclusions.

Hallux rigidus treated with adipose-derived mesenchymal stem cells:A case report

BACKGROUND First metatarsophalangeal joint arthritis(FMTPA),also known as hallux rigidus,is the most frequent degenerative disease of the foot.Diagnosis is made through both clinical and radiological evaluation.Regenerative medicine showed promising results in the treatment of early osteoarthritis.The aim of the present study was to report the results of a case of FMTPA treated with the injection of autologous adipose-derived mesenchymal stem cells.CASE SUMMARY A gentleman of 50 years of age presented with a painful hallux rigidus grade 2 resistant to any previous conservative treatment(including nonsteroidal antiinflammatory drugs and hyaluronic acid injections).An injection of autologous adipose-derived mesenchymal stem cells into the first metatarsophalangeal joint was performed.No adverse events were reported,and both function and pain scales improved after 9 mo of follow-up.CONCLUSION The FMTP joint injection of mesenchymal stem cells improved symptoms and function in our patient with FMTPA at 9 mo of follow-up.

Metallic resurfacing hemiarthroplasty of the first metatarsophalangeal joint combined with first metatarsal osteotomy for the treatment of hallux rigidus with hallux valgus in China

Hallux rigidus occurs mainly at the first metatarsophalangeal （MTP） joint,causing localized pain and degenerative arthritis.1 This condition frequently occurs together with hallux valgus and is difficult to treat.For hallux rigidus affecting only one joint,the treatment choices include articular debridement,resection arthroplasty,prosthetic arthroplasty,and arthrodesis,depending on the degree of arthritis.

Current concept in first metatarsophalangeal joint replacement

First metatarsophalangeal joint （MTPJ） degenerative diseases are not rare pathological changes in adult forefoot.1,2 It mainly includes hallux rigidus,hallux limitus and hallux valgus.3 Its progressive nature makes it hardly respond well to conservative treatment.4 Traditional surgical techniques,such as cheilectomy,Keller resection and arthrodesis are effective procedures but remain controversial due to none of them can achieve excellent results in all patients especially the end-stage conditions.5-7 Thus,great amount of efforts have been dedicated in MTPJ replacement despite many negative reports.This technique has aroused many controversies over the past decades due to its prematurity.Nevertheless,it has been improved in many aspects such as prosthesis material,design as well as surgical indications.This review would not only update the advancements and recognitions in recent years,but also presented the major disputed areas.