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Minimally Invasive vs Open First Metatarsophalangeal Joint Cheilectomy: Radiographic Outcomes and Early Complications
Noopur Ranganathan1,2, Marium Raza3, Soheil Ashkani-Esfahani1
1Foot & Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
Objectives:
Current literature on surgical techniques has evaluated minimally invasive surgery (MIS) cheilectomy and its efficacy in comparison to the open technique. However, no study to date has evaluated MIS-Moberg in relation to open and MIS cheilectomy. This study assessed radiological outcomes and early healing and complications of patients who underwent open, MIS, and MIS-Moberg cheilectomies.
Methods:
We conducted a retrospective cohort review of 134 patients who underwent first metatarsophalangeal (MTP) cheilectomy at an academic medical center between 2015 and 2024. Success of cheilectomy was determined radiographically. Postoperative complications were identified through medical record review.
Results:
73 open and 61 MIS cheilectomies were performed on 134 patients with a primary diagnosis of hallux rigidus. The pre-operative versus post-operative differences in dorsal cortical length (3.7±1.4) and sagittal articular P1 angle (7.3±4.8) were found to be statistically significant (P<0.05) for the MIS-Moberg group. Ten patients in the open cheilectomy were found to have dorsiflexion and plantarflexion stiffness compared to zero patients in the MIS and MIS-Moberg groups (P<0.01).
Conclusion:
We showed a significantly greater rate of plantar- and dorsiflexion stiffness in open surgeries compared to MIS and MIS-Moberg. No other differences in healing rates or radiologic outcomes were observed. Based on preliminary results, the MIS-Moberg can successfully alter the radiographic alignment of the great toe and does not increase complications as compared to open or MIS cheilectomy alone.
Insights
Minimally invasive surgery (MIS) Moberg cheilectomy for hallux rigidus showed no increased complications and improved joint motion compared to open or standard MIS techniques. This technique effectively alters radiographic alignment without compromising early healing.
Area of Science:
- Orthopedic Surgery
- Foot and Ankle Surgery
Background:
- Current literature compares minimally invasive surgery (MIS) cheilectomy to open techniques for hallux rigidus.
- No studies have evaluated the MIS-Moberg technique against open and standard MIS cheilectomy.
Purpose of the Study:
- To assess radiological outcomes, early healing, and complications of open, MIS, and MIS-Moberg cheilectomies.
- To compare the efficacy of MIS-Moberg cheilectomy with traditional open and MIS approaches.
Main Methods:
- Retrospective cohort review of 134 patients undergoing first metatarsophalangeal (MTP) cheilectomy (2015-2024).
- Radiographic assessment for surgical success and medical record review for postoperative complications.
Main Results:
- MIS-Moberg cheilectomy demonstrated statistically significant pre-operative to post-operative changes in dorsal cortical length and sagittal articular P1 angle.
- Open cheilectomy resulted in hallux rigidus stiffness in 10 patients, while MIS and MIS-Moberg groups had zero cases (P<0.01).
Conclusions:
- Open surgery is associated with a significantly higher rate of plantarflexion and dorsiflexion stiffness compared to MIS and MIS-Moberg techniques.
- MIS-Moberg cheilectomy effectively modifies radiographic alignment without increasing complications, showing comparable healing rates to open and standard MIS procedures.
