A Novel Technique for Soft-Tissue Defect Repair After Traumatic Rupture of the Extensor Hallucis Longus Tendon

2021 ◽  
Vol 111 (3) ◽  
Author(s):  
Ellianne Nasser ◽  
William Clark ◽  
Michael Gibboney
Keyword(s):  
Tendon Rupture ◽  
Metatarsophalangeal Joint ◽  
Soft Tissue Defect ◽  
Joint Capsule ◽  
Traumatic Rupture ◽  
First Metatarsophalangeal Joint ◽  
Novel Approach ◽  
Extensor Hallucis Longus ◽  
Physiologic Function ◽  
Capsular Defect

Background Surgical repair of extensor hallucis longus (EHL) tendon rupture with a concomitant capsular defect has not been reported in the literature. This case presents a novel approach to EHL tendon rupture repair along with repair of a first metatarsophalangeal joint capsule defect. Methods A case study is presented of a 61-year-old man with a traumatic EHL tendon rupture and capsular defect treated with an EHL tendon turndown flap and tenodesis to the extensor hallucis brevis and capsularis tendons with autograft flap reconstruction of the first metatarsophalangeal joint capsule. Discussion A 61-year-old man presented with an acute traumatic EHL tendon rupture and first metatarsophalangeal joint capsule compromise after a chainsaw injury. He subsequently lost dorsiflexion of his hallux, and magnetic resonance imaging confirmed a 2.2-cm gap in the EHL tendon. He was treated with an EHL tendon turndown flap and tenodesis to the extensor hallucis brevis and capsularis tendons to reestablish dorsiflexion to the hallux. The injury was noted to infiltrate the first metatarsophalangeal joint capsule and was treated with an autograft of the first metatarsophalangeal joint capsule for a capsular defect. At 1-year follow-up the patient has regained dorsiflexion of the hallux and is back to activities such as snow skiing without pain. Conclusions Ruptures of the EHL tendon with first metatarsophalangeal joint capsule defects have not been reported in the literature. Herein, a novel approach was used to reestablish physiologic function to the EHL tendon and provide sufficient coverage of the first metatarsophalangeal joint.

Extensor Hallucis Capsularis: Frequency and Identification on MRI

2006 ◽  
Vol 27 (3) ◽  
pp. 181-184 ◽  
Author(s):  
Nathan Boyd ◽  
Hugh Brock ◽  
Albert Meier ◽  
Richard Miller ◽  
Gary Mlady ◽  
...  
Keyword(s):  
Metatarsophalangeal Joint ◽  
Tendon Graft ◽  
Joint Capsule ◽  
Correct Prediction ◽  
Physical Parameters ◽  
Foot And Ankle ◽  
First Metatarsophalangeal Joint ◽  
Extensor Hallucis Longus ◽  
Mri Evaluation

Background: The extensor hallucis capsularis (EHC) is the most common name given to the accessory tendon sporadically seen medial to the extensor hallucis longus (EHL). We performed cadaver dissections and MRI evaluation to determine the frequency of its occurrence, the pattern of its origin and insertion, and its potential suitability as tendon graft. Methods: The EHC was examined by dissection in 81 cadaver feet. Physical parameters pertaining to EHC size and location were recorded. MRI was performed on six cadaver legs to determine if the EHC can be identified radiographically. MRI images were evaluated independently by a foot and ankle specialist and a radiologist. Results: The EHC was present in 71 (88%) of the specimens. It originated from the EHL tendon or muscle in 93% and inserted into the first metatarsophalangeal joint capsule in 99% of cases. All EHC tendons were less than or equal to 4 mm in width; only 16% were more than 2 mm wide. Correct prediction of the presence or absence of EHC by MRI varied according to EHC width: two of two in tendons more than 2 mm, five of eight in tendons 1 to 2 mm, and zero of two in tendons 1 mm or less. Conclusion: Up to 14% of the population may have an EHC tendon suitable for grafting in reconstructive surgeries, particularly surgeries related to hallux dysfunction. MRI may have a role in the preoperative identification of the EHC.

Structures at Risk During Percutaneous Extra-Articular Chevron Osteotomy of the Distal First Metatarsal

2019 ◽  
pp. 193864001989591
Author(s):  
Maria McGann ◽  
Travis M. Langan ◽  
Roberto A. Brandão ◽  
Gregory Berlet ◽  
Mark Prissel
Keyword(s):  
At Risk ◽  
Minimally Invasive ◽  
Hallux Valgus ◽  
Metatarsophalangeal Joint ◽  
Joint Capsule ◽  
Flexor Hallucis Longus ◽  
First Metatarsophalangeal Joint ◽  
Chevron Osteotomy ◽  
Extensor Hallucis Longus ◽  
Medial Eminence

Background. Minimally invasive surgery of the forefoot has regained popularity as an alternative to traditional open procedures. Minimally invasive hallux valgus surgery has been shown to be effective and reproducible for the treatment of mild to moderate hallux valgus. The aim of this study is to identify vital structures that are at risk for iatrogenic damage while performing a minimally invasive distal chevron osteotomy due to limited direct visualization. Methods. Ten fresh-frozen below knee cadavers were used for this study. A minimally invasive distal chevron osteotomy and medial eminence resection with a 2.2 mm × 22 mm Shannon burr was performed on each cadaver. Each specimen was dissected to expose the potential structures at risk for injury during the procedure. Structures evaluated included the medial neurovascular bundle, first metatarsophalangeal joint capsule, extensor hallucis longus tendon, flexor hallucis longus tendon, abductor hallucis tendon, and the sesamoid apparatus. Results. Ten specimens were evaluated. The dorsal medial cutaneous nerve was directly injured in 5 of the 10 cadaver specimens and intact/uninjured in the remaining 5 specimens. The flexor hallucis longus, extensor hallucis longus, adductor tendon, sesamoid apparatus, and first metatarsophalangeal joint capsule were uninjured in all specimens. Conclusion. Minimally invasive chevron distal osteotomy and medial eminence resection has a high learning curve. The resection of the medial eminence may iatrogenically injure the dorsal medial cutaneous nerve. The incidence is higher in this study than prior reported cadaveric studies and may warrant extra care to protect vital structures. Level of Evidence: Level IV: Cadaver study

The Modified Oblique Keller Procedure: A Technique for Dorsal Approach Interposition Arthroplasty Sparing the Flexor Tendons

2003 ◽  
Vol 24 (7) ◽  
pp. 521-522 ◽  
Author(s):  
Kenneth J. Mroczek ◽  
Stuart D. Miller
Keyword(s):  
Soft Tissues ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Resection Arthroplasty ◽  
Joint Capsule ◽  
Great Toe ◽  
Interposition Arthroplasty ◽  
Dorsal Approach ◽  
First Metatarsophalangeal Joint ◽  
Satisfactory Outcome

A first metatarsophalangeal joint resection arthroplasty that combines a modest metatarsal cheilectomy with an oblique resection of the phalanx base (preserving the flexor hallucis brevis attachment) combined with interposition arthroplasty of the dorsal joint capsule sewn to the plantar soft tissues is presented. Numerous surgical procedures have been described for the treatment of hallux rigidus, including dorsal cheilectomy, resection arthroplasty, joint replacement, and arthrodesis. The Keller procedure has been abandoned by many because of shortening of the great toe and loss of push-off power. The modified oblique Keller technique described here allows for intraoperative transition from cheilectomy to resection arthroplasty with what appears to be a satisfactory outcome, maintaining plantarflexion power and hallux length.

First Metatarsophalangeal Joint Arthrodesis Using Memory Staples: Clinical and Functional Results

2020 ◽  
pp. 193864002092157
Author(s):  
Sudhakar Rao Challagundla ◽  
Roshin Thomas ◽  
Rupert Ferdinand ◽  
Evan Crane
Keyword(s):  
Metatarsophalangeal Joint ◽  
Functional Results ◽  
Hallux Rigidus ◽  
Union Rate ◽  
First Metatarsophalangeal Joint ◽  
Patient Satisfaction Scores ◽  
Extensor Hallucis Longus ◽  
The Mean ◽  
Ability Measure

Background. We present clinical and functional results of first metatarsophalangeal joint (MTPJ) arthrodesis using Memory staples. Methods. This retrospective observational study reviewed MTPJ arthrodesis with Memory staples from 2012 to 2016. Results. The mean age of 50 patients (55 feet) was 63 years (range 41-77 years). Forty-one feet were in women. Indication was hallux rigidus (n = 49) and hallux valgus (n = 6). The overall union rate was 98.2% (n = 54 of 55), including delayed healing in 3 (5.5%). The average time to union was 12 weeks. At a mean follow-up of 38 months (range 12-73 months), the mean Foot and Ankle Ability Measure score (47 out of 55, 86% response rate) was 87% (interquartile range 78%-100%). Complications included partial laceration of extensor hallucis longus (n = 1), wound infection (n = 4), wound-related (n = 2), lesser metatarsalgia (n = 3), cock up deformity (n = 1), and pain (n = 3). Conclusions. The high union rate, good patient satisfaction scores, and low rate of complications support our use of Memory staples. Levels of Evidence: Therapeutic, Level IV

Traumatic Hallux Varus in Association with Agenesis of the Fibular Sesamoid: A Case Study

2019 ◽  
Vol 109 (3) ◽  
pp. 246-252
Author(s):  
Tracy Lee ◽  
Erik Monson
Keyword(s):  
Tendon Transfer ◽  
Metatarsophalangeal Joint ◽  
Lateral Release ◽  
First Metatarsophalangeal Joint ◽  
First Metatarsal ◽  
Hallux Varus ◽  
Bilateral Absence ◽  
Extensor Hallucis Longus ◽  
Medial Eminence

Hallux varus is most commonly seen iatrogenically following overaggressive lateral release, removal of the fibular sesamoid, or overaggressive removal of the medial eminence. There are several reported cases of traumatic hallux varus, although this is much less common. We present a case of traumatic hallux varus in a patient who was later found to have bilateral absence of her fibular sesamoids. We postulated that lack of her fibular sesamoid led to weakness of her lateral capsular ligaments, thereby making her more susceptible to this injury. We performed a repair using a split extensor hallucis longus tendon transfer that was transected proximally, rerouted the tendon under the deep transverse intermetatarsal ligament, and secured it to the first metatarsal with a Bio-Tenodesis (Arthrex, Inc, Naples, Florida) screw. At 22 months postoperatively, she has demonstrated maintenance of correction and has resumed use of normal shoe gear and participation in activities. Our goal was to demonstrate a repair for this condition that successfully maintained correction over time while still allowing for functionality of the first metatarsophalangeal joint.

Capsular Interposition for the Keller Bunionectomy with the Use of Soft-Tissue Anchors

2005 ◽  
Vol 95 (2) ◽  
pp. 180-182 ◽  
Author(s):  
Keith D. Cook
Keyword(s):  
Soft Tissue ◽  
Metatarsophalangeal Joint ◽  
Joint Space ◽  
Joint Capsule ◽  
Past Century ◽  
First Metatarsophalangeal Joint ◽  
The Past ◽  
Joint Pathology ◽  
Capsular Flap

The Keller procedure has been used during the past century for the treatment of first metatarsophalangeal joint pathology. Many modifications to the procedure have been made, including interposition of the joint capsule into the first metatarsophalangeal joint space. Capsular interposition is often the most difficult step in performing the Keller bunionectomy. This article describes a new, simplified technique for capsular interposition with the use of a dorsal capsular flap and soft-tissue anchors. (J Am Podiatr Med Assoc 95(2): 180–182, 2005)

The Venous Pump of the First Metatarsophalangeal Joint: Clinical Implications

2007 ◽  
Vol 28 (8) ◽  
pp. 902-909 ◽  
Author(s):  
Andreas Elsner ◽  
Gereon Schiffer ◽  
Axel Jubel ◽  
Jürgen Koebke ◽  
Prof. J. Andermahr
Keyword(s):  
Venous Blood ◽  
Metatarsophalangeal Joint ◽  
Joint Capsule ◽  
Ankle Injuries ◽  
Active Movement ◽  
Venous Blood Flow ◽  
First Metatarsophalangeal Joint ◽  
Anatomy And Physiology ◽  
Venous Circulation ◽  
Venous Valves

Background: Although the anatomy and physiology of the venous circulation of the ankle and midfoot are well documented, the physiologic importance of forefoot mobility has not been reported in the literature. The question of this study was whether the first metatarsophalangeal (MTP) joint may operate, like the ankle, as a “pump” to encourage venous return. Methods: Forty-nine cadaver foot specimens were examined using dissection, plastination, vessel infiltration, and maceration, and radiographic (including venography, MRI, and magnetic resonance angiography) techniques. The anatomy and physiology were described and compared to the ankle joint. Forty patients had biphasic Doppler flow studies. Results: The major finding was the medial drainage of the plantar venous sinus, which is fibrotically bound to the joint capsule. Functional venous valves were evident distally and within fibrous vascular lumens. Mobilization of the first MTP joint led to compression and emptying of the veins. Passive mobilization of the first MTP joint led to an average flow increase of 55% ± 7 ( p < 0.0001), while active movement led to an average increase of 78% ± 7 ( p < 0.0001). Conclusions: Our described connection between the joint capsule and veins indicates a “toe-ankle pump” with a significant increase of venous blood flow during motion of the MTP joint. Possible clinical applications for an external MTP pump include anti-edema or thromboprophylactic therapy, especially in patients with foot or ankle injuries. A new toe-pump has been designed based on these results.

scholarly journals Chronic extensor hallucis longus tendon rupture treated with double-bundle autograft of extensor hallucis capsularis: A case report

2019 ◽  
Vol 7 ◽  
pp. 2050313X1984196 ◽  
Author(s):  
Toshinori Kurashige
Keyword(s):  
Tendon Rupture ◽  
Metatarsophalangeal Joint ◽  
Extensor Tendon ◽  
Double Bundle ◽  
Level Of Evidence ◽  
Longus Tendon ◽  
First Case ◽  
Extensor Hallucis Longus ◽  
The Right

The extensor hallucis capsularis is an accessory extensor tendon with varied occurrence. Here, we present the case of a 40-year-old man with chronic extensor hallucis longus tendon rupture treated using extensor hallucis capsularis tendon as a double-bundle autograft. He had dropped a knife proximal to the right hallux metatarsophalangeal joint 4 months ago. Computed tomography revealed the presence of extensor hallucis capsularis, with its width and thickness, and the point of divergence from the extensor hallucis longus tendon. Because direct suturing was considered difficult and the extensor hallucis capsularis tendon was sufficiently wide and long, double-bundle autograft transplantation of extensor hallucis capsularis was performed. At 1-year follow-up examination, the patient retained almost full function of his hallux. To the best of our knowledge, this is the first case to use this technique. Using the extensor hallucis capsularis tendon for grafting should be carefully considered because the variable width and length may limit the graft strength. Level of evidence: IV

Incarcerated Plantar Dislocation of the First Metatarsophalangeal Joint: Reduction Using Intra-articular Saline Injection

2018 ◽  
Vol 11 (5) ◽  
pp. 467-470 ◽  
Author(s):  
Daniel D. Bohl ◽  
Kamran S. Hamid ◽  
David M. Walton
Keyword(s):  
Case Report ◽  
Open Reduction ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Joint Capsule ◽  
Saline Injection ◽  
Therapeutic Level ◽  
First Metatarsophalangeal Joint ◽  
Joint Reduction ◽  
Plantar Dislocation

Plantar dislocation of the first metatarsophalangeal (MTP) joint is exceedingly rare, and in prior reported cases, simple closed manipulation easily enabled reduction. We present here the first reported plantar dislocation that failed closed manipulation. We also report a technique involving injection of saline into the joint to facilitate reduction. The saline insufflation likely relieves buttonholing of the metatarsal head through the dorsal joint capsule. For first MTP joint plantar dislocations that fail reduction with manipulation, we recommend attempting injection of the joint with saline prior to subjecting the patient to open reduction. Levels of Evidence: Therapeutic, Level IV: Case report

Correlation analysis of the x-ray and functional parameters from the results of chevron (Austin) osteotomy for hallux valgus

2020 ◽  
pp. 54-63
Author(s):  
Ruslan Khairutdinov ◽  
Timur Minasov ◽  
Ekaterina Yakupova ◽  
Elvina Mukhametzyanova
Keyword(s):  
Hallux Valgus ◽  
Rating Scale ◽  
Metatarsophalangeal Joint ◽  
Valgus Deformity ◽  
First Metatarsophalangeal Joint ◽  
Chevron Osteotomy ◽  
Hallux Valgus Deformity ◽  
Valgus Angle ◽  
The Right ◽  
Bone Structures

Hallux valgus is characterized by the appearance and growth of a painful “lump” in the region of the first metatarsophalangeal joint, the development of forefoot corns, and inability to choose the right shoes, which leads to a significant decrease in the quality of life of these patients. Corrective osteotomies that preserve the metatarsophalangeal joint, for example Austin (Chevron) osteotomy, are usually used for hallux valgus deformity of the I, II degrees. Radiography with the study of the hallux valgus angle (HVA), the intermetatarsal angle (IMA), the distal metatarsal articular angle (DMAA) is a research method that shows the true correlation between bone structures. The correlation between the radiological and functional indicators of osteotomy allows us to determine possible recommendations for indications for surgical treatment of Hallux valgus. Correlation shows that the largest correction of hallux valgus in older patients occurs due to a small adjustment of the angle of DMMA and HVA. IMA had the best correction after Austin osteotomy among patients of a younger age, then the HVA, and the DMMA had minimum correction according to the AOFAS rating scale (Kitaoka). The revealed correlations allow us to determine the correct tactics for the treatment of hallux valgus by identifying the benefits of Austin osteotomy.

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