Background

Several techniques and approaches for first metatarsophalangeal (MTP1) joint arthroscopy have been reported, where joint accessibility plays a key role. This study aimed to evaluate differences in arthroscopic accessibility of the first metatarsal head (MTH1) comparing non-invasive distraction and maximum plantarflexion in a two-portal approach.

Methods

Forty fresh-frozen lower leg specimens were included and divided into a distraction group (D-group) and a plantarflexion group (PF-group). A two-portal technique (1.9 mm-30°-scope) was used for arthroscopy, maximum reach at the MTH1 was marked. Following arthroscopy, specimens were dissected and examined for iatrogenic injuries. The reached area at the chondral surface was pinned and accessibility calculated.

Results

Accessibility of the MTH1 was 58.03 % ± 13.64 (D-group) and 55.93 % ± 10.30 (PF-group, p = 0.51). The dorsomedial hallucal nerve was injured in one specimen (2.5 %).

Conclusion

Maximum plantarflexion showed no difference in arthroscopic MTP1 joint accessibility compared to non-invasive distraction in a two-portal approach. During dorsomedial portal placement, the dorsomedial hallucal nerve is at risk for iatrogenic injury.

中文翻译：

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通过双孔技术对第一跖趾关节进行关节镜可及性治疗跖骨头骨软骨缺损——比较关节牵引和跖屈

背景

已经报道了第一跖趾 (MTP1) 关节镜检查的几种技术和方法，其中关节可及性起着关键作用。本研究旨在评估第一跖骨头 (MTH1) 的关节镜可及性差异，比较双入路入路中的非侵入性撑开和最大跖屈。

方法

40 例新鲜冷冻的小腿标本被分为牵引组（D组）和跖屈组（PF 组）。双入口技术（1.9 mm-30° 范围）用于关节镜检查，标记了 MTH1 的最大范围。关节镜检查后，解剖标本并检查医源性损伤。固定软骨表面的到达区域并计算可访问性。

结果

MTH1 的可及性为 58.03 % ± 13.64（D组）和 55.93 % ± 10.30（PF 组，p = 0.51）。一个样本 (2.5%) 的背内侧拇指神经受损。

结论

与双入口方法中的非侵入性牵引相比，最大跖屈在关节镜下 MTP1 关节可及性方面没有差异。在背内侧入路放置期间，背内侧拇指神经有发生医源性损伤的风险。