SOFT TISSUE BALANCING OF THE SUBLUXATED SECOND METATARSOPHALANGEAL JOINT – A 2 TO 10 YEARS FOLLOW-UP

Abstract

Background: We present a prospective two to ten year follow-up of soft tissue balancing surgery at the subluxated second MTP joint. The purpose of this study was to find out the effect of soft tissue balancing techniques of the second MTP joint on long term VAS and AOFAS results. As second hypotheses we compared the results of two different techniques, one group with additional transarticular Kirschner wire (KW) fixation of the second MTP joint temporary for 3 weeks postoperative and the other group without.

Materials and Methods: Fifty-four patients, 45 women and nine men, with a total of 62 operative interventions were included in our follow-up evaluation. Soft tissue balancing techniques we used were capsulotomy, lengthening of the extensor tendons, incision of the collateral ligaments and intrinsic muscles with or without temporary transarticular Kirschner wire (KW) fixation.

Pre- und postoperative VAS and AOFAS scores, as well as clinical and radiological findings were analyzed. One weightbearing and one without weightbearing dorsoplantar radiograph as well as a 45 degrees rotated radiograph were done pre and postoperatively to proof the position of the second toe.

Results: The statistical calculations showed a highly significant outcome (p< 0.0001) comparing pre- to postoperative scores.

Explorative data analysis as well as chi-square tests comparing the two groups - 29 second toes with and 33 second toes without temporarily additional transarticular KW fixation of the MTP joint - showed homogeneous distribution of all scores.

Conclusion: Our evaluation showed highly significant improvement with soft tissue balancing for subluxated second MTP joint of the second metatarsal, but no benefit from additional KW fixation of the MTP joint.