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Evaluation of Clinical Outcomes After Cheilectomy and Microfracture in Hallux Rigidus

Yıl 2025, Cilt: 47 Sayı: 6, 990 - 996, 26.09.2025
https://doi.org/10.20515/otd.1721214

Öz

Halluks rigidus (HR), birinci metatarsofalangeal eklemi etkileyen ve ağrı, sertlik ile fonksiyonel kısıtlılıklara neden olan yaygın bir osteoartrit formudur. Eklem koruyucu bir cerrahi yöntem olan çelyektomi, erken ve orta evre HR olgularında sıklıkla tercih edilmektedir. Mikrokırık tekniği ise kıkırdak tamirini hedefleyen ve fibrokartilaj oluşumunu uyaran bir yöntemdir. Bu retrospektif çalışmada, Ocak 2019 ile Eylül 2023 tarihleri arasında çelyektomi uygulanan 62 hasta değerlendirildi. Hastalar sadece çelyektomi yapılanlar (Grup 1, n=32) ve çelyektomiye ek mikrokırık uygulananlar (Grup 2, n=30) olarak iki gruba ayrıldı. Ortalama takip süresi Grup 1’de 25,8 ± 7,2 ay (18–40 ay aralığında), Grup 2’de ise 23,1 ± 7,3 ay (16–42 ay aralığında) idi. Fonksiyonel sonuçlar; American Orthopaedic Foot and Ankle Society (AOFAS) skoru, Vizüel Analog Skala (VAS) ağrı skoru ve dorsifleksiyon (DF) açıları kullanılarak değerlendirildi. Her iki grupta postoperatif tüm parametrelerde istatistiksel olarak anlamlı iyileşme izlendi (p<0.001); ancak AOFAS skorları mikrokırık uygulanan grupta anlamlı olarak daha yüksekti (p=0.0168). Gruplar arasında VAS ve DF açısı açısından anlamlı fark saptanmadı. Bulgular, çelyektomiye ek olarak uygulanan mikrokırık tekniğinin kısa ve orta vadede fonksiyonel sonuçları artırabileceğini göstermektedir. Ancak yöntemin uzun dönem etkinliğinin değerlendirilmesi için ileriye dönük çalışmalara ihtiyaç vardır.

Kaynakça

  • 1. Hamid KS, Parekh SG. Clinical presentation and management of hallux rigidus. Foot Ankle Clin. 2015;20(3):391–9.
  • 2. Lam A, Chan JJ, Surace MF, Vulcano E. Hallux rigidus: how do I approach it? World J Orthop. 2017;18;8(5):364–71.
  • 3. Kunnasegaran R, Thevendran G. Hallux rigidus: nonoperative treatment and orthotics. Foot Ankle Clin. 2015;20(3):401–12.
  • 4. Anderson MR, Ho BS, Baumhauer JF. Republication of "Current concepts review: hallux rigidus". Foot Ankle Orthop. 2023;8(3):24730114231188123.
  • 5. Coughlin MJ, Shurnas PS. Hallux rigidus: demographics, etiology, and radiographic assessment. Foot Ankle Int. 2003;24(10):731–43.
  • 6. Lee HY, Mansur NS, Lalevee M, Maly C, Iehl CJ, Hembree WC, Godoy-Santos A, de Cesar Netto C. Does metatarsus primus elevatus really exist in hallux rigidus? A weightbearing CT case-control study. Arch Orthop Trauma Surg. 2023;143(2):755–61.
  • 7. Sidon E, Rogero R, Bell T, McDonald E, Shakked RJ, Fuchs D, Daniel JN, Pedowitz DI, Raikin SM. Long-term follow-up of cheilectomy for treatment of hallux rigidus. Foot Ankle Int. 2019;40(10):1114–21.
  • 8. Gill TJ, Asnis PD, Berkson EM. The treatment of articular cartilage defects using the microfracture technique. J Orthop Sports Phys Ther. 2006;36(10):728–38.
  • 9. Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res. 2001;(391 Suppl):S362–9.
  • 10. Coughlin MJ, Shurnas PS. Hallux rigidus. Grading and long-term results of operative treatment. J Bone Joint Surg Am. 2003;85(11):2072–88.
  • 11. Zammit GV, Munteanu SE, Menz HB. Development of a diagnostic rule for identifying radiographic osteoarthritis in people with first metatarsophalangeal joint pain. Osteoarthritis Cartilage. 2011;19(8):939–45.
  • 12. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15(7):349–53.
  • 13. Doty J, Coughlin M, Hirose C, Kemp T. Hallux metatarsophalangeal joint arthrodesis with a hybrid locking plate and a plantar neutralization screw: a prospective study. Foot Ankle Int. 2013;34(11):1535–40.
  • 14. Keiserman LS, Sammarco VJ, Sammarco GJ. Surgical treatment of the hallux rigidus. Foot Ankle Clin. 2005;10(1):75–96.
  • 15. Nicolosi N, Hehemann C, Connors J, Boike A. Long-term follow-up of the cheilectomy for degenerative joint disease of the first metatarsophalangeal joint. J Foot Ankle Surg. 2015;54(6):1010–20.
  • 16. de Bot RTAL, Veldman HD, Eurlings R, Stevens J, Hermus JPS, Witlox AM. Metallic hemiarthroplasty or arthrodesis of the first metatarsophalangeal joint as treatment for hallux rigidus: a systematic review and meta-analysis. Foot Ankle Surg. 2022;28(2):139–152.
  • 17. Sebag JA, Clements RC, Togher CJ, Connolly EC. The first metatarsophalangeal joint: updates on revision arthrodesis and malunions. Clin Podiatr Med Surg. 2023;40(4):569–580.
  • 18. Sommerfeldt MF, Magnussen RA, Hewett TE, Kaeding CC, Flanigan DC. Microfracture of articular cartilage. JBJS Rev. 2016;4(6):e6.
  • 19. Goyal D, Keyhani S, Lee EH, Hui JH. Evidence-based status of microfracture technique: a systematic review of level I and II studies. Arthroscopy. 2013;29(9):1579–88.
  • 20. Becher C, Kilger R, Thermann H. Results of cheilectomy and additional microfracture technique for the treatment of hallux rigidus. Foot Ankle Surg. 2005;11(3):155–60.
  • 21. Huang D, Png W, Rikhraj IS, Cher EWL. Cheilectomy, osteotomy, microfracture, and matrix-induced chondrogenesis (COMM): a novel combined procedure for treating hallux rigidus. Cartilage. 2025 May 22.

Evaluation of Clinical Outcomes After Cheilectomy and Microfracture in Hallux Rigidus

Yıl 2025, Cilt: 47 Sayı: 6, 990 - 996, 26.09.2025
https://doi.org/10.20515/otd.1721214

Öz

Hallux rigidus (HR) is a common form of osteoarthritis that affects the first metatarsophalangeal joint, causing pain, stiffness, and functional limitations. Cheilectomy, a joint-preserving surgical method, is often used in early to mid-stage HR. Microfracture is a cartilage repair technique that stimulates fibrocartilage formation. This retrospective study evaluated and compared the clinical outcomes of 62 patients who underwent cheilectomy alone (Group 1, n=32) or cheilectomy combined with microfracture (Group 2, n=30) between January 2019 and September 2023. The mean follow-up duration was 25.8 ± 7.2 months (range, 18–40 months) in Group 1 and 23.1 ± 7.3 months (range, 16–42 months) in Group 2. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, Visual Analog Scale (VAS) for pain, and dorsiflexion (DF) angles. Both groups demonstrated statistically significant improvements in all parameters postoperatively (p<0.001), while the AOFAS scores were significantly higher in the combined microfracture group (p=0.0168). No significant differences were observed in VAS and DF angle values between the groups. These findings suggest that the addition of microfracture to cheilectomy may enhance short- to mid-term functional outcomes without increasing complications. Further prospective, long-term studies are required to confirm its sustained effectiveness and potential benefits in the treatment of hallux rigidus.

Etik Beyan

The study was approved by Gülhane Training and Research Hospital Clinical Research Ethics Committee (Decision No: 2024/249, Date: 28.05.2024)

Destekleyen Kurum

Yok

Teşekkür

Yok

Kaynakça

  • 1. Hamid KS, Parekh SG. Clinical presentation and management of hallux rigidus. Foot Ankle Clin. 2015;20(3):391–9.
  • 2. Lam A, Chan JJ, Surace MF, Vulcano E. Hallux rigidus: how do I approach it? World J Orthop. 2017;18;8(5):364–71.
  • 3. Kunnasegaran R, Thevendran G. Hallux rigidus: nonoperative treatment and orthotics. Foot Ankle Clin. 2015;20(3):401–12.
  • 4. Anderson MR, Ho BS, Baumhauer JF. Republication of "Current concepts review: hallux rigidus". Foot Ankle Orthop. 2023;8(3):24730114231188123.
  • 5. Coughlin MJ, Shurnas PS. Hallux rigidus: demographics, etiology, and radiographic assessment. Foot Ankle Int. 2003;24(10):731–43.
  • 6. Lee HY, Mansur NS, Lalevee M, Maly C, Iehl CJ, Hembree WC, Godoy-Santos A, de Cesar Netto C. Does metatarsus primus elevatus really exist in hallux rigidus? A weightbearing CT case-control study. Arch Orthop Trauma Surg. 2023;143(2):755–61.
  • 7. Sidon E, Rogero R, Bell T, McDonald E, Shakked RJ, Fuchs D, Daniel JN, Pedowitz DI, Raikin SM. Long-term follow-up of cheilectomy for treatment of hallux rigidus. Foot Ankle Int. 2019;40(10):1114–21.
  • 8. Gill TJ, Asnis PD, Berkson EM. The treatment of articular cartilage defects using the microfracture technique. J Orthop Sports Phys Ther. 2006;36(10):728–38.
  • 9. Steadman JR, Rodkey WG, Rodrigo JJ. Microfracture: surgical technique and rehabilitation to treat chondral defects. Clin Orthop Relat Res. 2001;(391 Suppl):S362–9.
  • 10. Coughlin MJ, Shurnas PS. Hallux rigidus. Grading and long-term results of operative treatment. J Bone Joint Surg Am. 2003;85(11):2072–88.
  • 11. Zammit GV, Munteanu SE, Menz HB. Development of a diagnostic rule for identifying radiographic osteoarthritis in people with first metatarsophalangeal joint pain. Osteoarthritis Cartilage. 2011;19(8):939–45.
  • 12. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994;15(7):349–53.
  • 13. Doty J, Coughlin M, Hirose C, Kemp T. Hallux metatarsophalangeal joint arthrodesis with a hybrid locking plate and a plantar neutralization screw: a prospective study. Foot Ankle Int. 2013;34(11):1535–40.
  • 14. Keiserman LS, Sammarco VJ, Sammarco GJ. Surgical treatment of the hallux rigidus. Foot Ankle Clin. 2005;10(1):75–96.
  • 15. Nicolosi N, Hehemann C, Connors J, Boike A. Long-term follow-up of the cheilectomy for degenerative joint disease of the first metatarsophalangeal joint. J Foot Ankle Surg. 2015;54(6):1010–20.
  • 16. de Bot RTAL, Veldman HD, Eurlings R, Stevens J, Hermus JPS, Witlox AM. Metallic hemiarthroplasty or arthrodesis of the first metatarsophalangeal joint as treatment for hallux rigidus: a systematic review and meta-analysis. Foot Ankle Surg. 2022;28(2):139–152.
  • 17. Sebag JA, Clements RC, Togher CJ, Connolly EC. The first metatarsophalangeal joint: updates on revision arthrodesis and malunions. Clin Podiatr Med Surg. 2023;40(4):569–580.
  • 18. Sommerfeldt MF, Magnussen RA, Hewett TE, Kaeding CC, Flanigan DC. Microfracture of articular cartilage. JBJS Rev. 2016;4(6):e6.
  • 19. Goyal D, Keyhani S, Lee EH, Hui JH. Evidence-based status of microfracture technique: a systematic review of level I and II studies. Arthroscopy. 2013;29(9):1579–88.
  • 20. Becher C, Kilger R, Thermann H. Results of cheilectomy and additional microfracture technique for the treatment of hallux rigidus. Foot Ankle Surg. 2005;11(3):155–60.
  • 21. Huang D, Png W, Rikhraj IS, Cher EWL. Cheilectomy, osteotomy, microfracture, and matrix-induced chondrogenesis (COMM): a novel combined procedure for treating hallux rigidus. Cartilage. 2025 May 22.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Ortopedi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Uğur Yüzügüldü 0000-0002-3378-2497

Mustafa Aydın 0000-0002-9066-4606

Anıl Özgür 0000-0002-5877-0628

Yayımlanma Tarihi 26 Eylül 2025
Gönderilme Tarihi 17 Haziran 2025
Kabul Tarihi 4 Eylül 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 47 Sayı: 6

Kaynak Göster

Vancouver Yüzügüldü U, Aydın M, Özgür A. Evaluation of Clinical Outcomes After Cheilectomy and Microfracture in Hallux Rigidus. Osmangazi Tıp Dergisi. 2025;47(6):990-6.


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