Sesamoid excision during first metatarsophalangeal joint arthrodesis via a transarticular approach: A cadaveric study

Abstract

Sesamoids of the first metatarsophalangeal joint can be a source of residual pain after surgical intervention for hallux rigidus. Theoretically, after fusion of the first metatarsophalangeal joint there should be little to no motion at the metatarsosesamoid articulations; however in many cases significant arthritis disease of the sesamoids may create hypertrophy and pain. Residual motion about the sesamoid articulations could result in recalcitrant pain after joint arthrodesis. Previous studies have discussed surgical sesamoidectomy for treatment of painful sesamoid bones, while frequently advocating for ancillary incisions in an attempt to obtain direct visualization. The goals of this cadaveric study were to identify any observable motion of the sesamoid bones after simulated first MTP joint fusion and assess if adequate visualization of the sesamoid bones can be obtained for proper excision through a standard dorsomedial approach. Using live fluoroscopy, no residual sesamoid range of motion was noted after fusion fixation. We were able to perform successful total sesamoidectomy in all specimens (n = 10) via the transarticular approach, with only 1 incident of minor tendon injury. Total sesamoidectomy took an average of 2:10 minutes, and average incision length was 4.9 cm. Despite the cadaveric nature of the present study, our results confirm a lack of motion to the sesamoid articulations after arthrodesis of the first MTP joint. Furthermore, using the transarticular technique discussed in this study, we exhibited that the standard dorsomedial approach can be used for safe and efficient sesamoidectomy, when indicated in conjunction with first MTP joint arthrodesis.

Keywords

• Sesamoid
• Metatarsophalangeal
• Osteoarthritis
• Metatarsosesamoid