Sesamoid Avascular Necrosis and Stress Fracture Treated with Core Decompression and Biologic Augmentation

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Regenerative Medicine

Background:

• Sesamoid bone disorders, including avascular necrosis (AVN), significantly impact athletes, presenting limited therapeutic options.
• Hallux sesamoids are crucial for first metatarsophalangeal joint function, and their disorders can lead to disabling pain and limited mobility.

Observation:

• A 17-year-old football player presented with bilateral hallux sesamoid AVN and a tibial sesamoid stress fracture.
• Initial conservative management was insufficient, necessitating surgical intervention.

Findings:

• The patient underwent open sesamoid core decompression combined with concentrated bone marrow aspirate and amnion matrix application.
• Postoperative physical therapy facilitated a painless range of motion in the first metatarsophalangeal joint.
• The patient successfully returned to full athletic activities within six months.

Implications:

• Core decompression with biologic augmentation represents a viable surgical strategy for treating sesamoid AVN.
• Early surgical intervention should be considered for younger, active patients with sesamoid AVN to optimize outcomes.
• This case highlights the potential for advanced regenerative techniques in managing complex sesamoid bone disorders.