A Soft-Tissue Interpositional Arthroplasty Technique of the First Metatarsophalangeal Joint for the Treatment of Advanced Hallux Rigidus Using a Human Acellular Dermal Regenerative Tissue Matrix

Treatment options for young and active patients with advanced hallux rigidus of the first metatarsophalangeal joint are limited. Soft-tissue interpositional arthroplasty is a promising alternative. A minimally invasive interpositional arthroplasty technique using a human acellular regenerative tissue matrix is described. The preliminary results of a consecutive series of the first 8 patients with Coughlin grade 3 classifications who underwent this procedure are presented. Five patients were women and 3 were men, with a mean age of 50.2 years and a mean body mass index of 27.6. The mean length of follow-up was 10.1 months, with no reported failures. No complications, such as infection, inflammatory reactions, push-off strength loss, malalignment, or instability occurred. The mean total American Orthopaedic Foot and Ankle Society score and pain subscore were significantly higher at the most recent follow-up (89.6 and 35, respectively) versus preoperatively (66.7 and 20, respectively). The improvement in Coughlin classification to a mean grade of 1.6 was also statistically significant. These excellent early results and lack of complications may be because of the minimally invasive nature of the procedure. This technique does not require autograft harvesting, is bone-sparing, and maintains the natural intrinsics of the joint by preserving its associated tendons and the flexor hallucis and brevis insertion. The sesamoid articulation also is resurfaced, which may further extend the survivorship of the procedure. Although further follow-up is needed, the use of this minimally invasive technique as the first surgical intervention for the treatment of advanced hallux rigidus may offer the young and active patient an opportunity to maintain an active lifestyle while reserving the possibility for more aggressive surgical options should the condition progress.