Arthroscopic Lapidus Arthrodesis of the First Tarsometatarsal Joint for Treatment of Hallux Valgus Deformity of the Foot

ABSTRACT: Hypermobility of the first tarsometatarsal joint can associate with different clinical problems, e.g., hallux valgus, hallux elevatus, hallux rigidus, and transverse metatarsalgia or arthritis of the second metarsocuneiform joint. The first tarsometatarsal joint may also contribute to other foot deformities involving the medial foot column. Osteoarthritis of this joint is one of the causes of medial foot pain. Arthrodesis of the first tarsometatarsal joint (modified Lapidus procedure) is indicated for these conditions, which are resistant to conservative treatment. Lapidus arthrodesis has several potential complications, including first metatarsal shortening, metatarsal elevates, and nonunion. Arthroscopic Lapdius arthrodesis has been reported to reduce these complications. In this Technical Note, the technical details of arthroscopic Lapidus arthrodesis is described. Technique Video Video 1 Arthroscopic Lapidus arthrodesis of the left foot. The patient is in supine position with the legs spread. The plantar medial portal is the viewing portal, and the dorsomedial portal is the working portal. The cartilage of the dorsal part of the joint is stripped from the subchondral bone by an arthroscopic osteotome and removed with a hemostat. The arthroscope is switched to the dorsomedial portal. The cartilage of the plantar part of the joint is stripped from the subchondral bone by an arthroscopic osteotome and removed with a hemostat. The arthroscope is switched back to the plantar medial portal. The subchondral bone is microfractured with an arthroscopic awl via the dorsomedial portal. Finally, the joint is reduced into the desired position and is transfixed with two 4-mm cannulated screws: one across the first tarsometatarsal joint and another one across bases of 1st, 2nd, and 3rd metatarsals.

SUBMITTER: Yeung T 

PROVIDER: S-EPMC9244635 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature