Summary

Arthroscopy for hallux rigidus can be applied with impressive functional scores and without any complications in persons who failed conservative therapy.

Abstract

Hallux rigidus (HR) is common in foot surgery consultations. Several surgical techniques have been described in the literature. First metatarsophalangeal arthroscopy (MTP1), used alone or in combination with osteotomies, has been the subject of many technical descriptions but few comparative studies.
In this retrospective study of 35 patients (39 HR) treated between 2014 and 2018, we compared the results of treatment by arthroscopy versus percutaneous technique by analyzing the results on the function of the foot. The Coughlin and Shurnas classification was used to determine the severity of HR. Functional results were assessed by the AOFAS score.
Our population was divided into two groups: 21 hallux treated by arthroscopy (G1) and 18 HR operated by percutaneous surgery (G2). The two groups were homogeneous with no significant differences in sex and age.
Preoperatively, the mean mobility of MTP1 in G1 was 38.9 ° for dorsiflexion (DF) and 12.7 ° for plantar flexion (PF). The preoperative mean mobility of MTP1 in G2 was 34 ° (DF) and 10.5 ° (FP). At the last follow-up (17.7 months for G1 and 37.5 months for G2), the mean DF was 87 ° and 73 ° respectively for G1 and G2. The PF was more important in the G1 with 17 ° against only 11 ° for the G2. The mean AOFAS score, calculated preoperatively, was 42 and 45 respectively for G 1 and G2. At the last follow-up the score was 88 for G1 against 75 for G2. One surgical site infection and two cases of dystrophy were noted in our series.
Our results confirm the superiority of arthroscopic treatment. The postoperative consequences, the recovery rate and the functional scores are better in the short and medium term. This is an evolving pathology and the data in the literature, like our series, do not have sufficient hindsight to assess and compare these results with other techniques.