Comparison of Clinical Outcomes Between Cheilectomy and Proximal Phalangeal Dorsiflexion Osteotomy With and Without Bone Marrow Aspirate Concentrate and Extracellular Matrix for Hallux Rigidus

Abstract

Background:

Hallux rigidus with an associated osteochondral lesion is a common condition that can effectively be treated with a cheilectomy and Moberg osteotomy (CM). The use of biological adjuncts such as extracellular matrix (ECM) and bone marrow aspirate concentrate (BMAC) have been suggested to facilitate healing and restore forefoot function. The aim was to report if the addition of ECM and BMAC improves clinical outcomes for the treatment of hallux rigidus.

Methods:

Patients who received open cheilectomy with first proximal phalangeal dorsal closing wedge osteotomy with and without ECM and BMAC for the diagnosis of hallux rigidus between February 2016 to July 2022 by the principal investigator were reviewed. A total of 137 patients were included, 71 in the cheilectomy with Moberg osteotomy group (CM) and 66 in the cheilectomy with Moberg osteotomy and ECM/BMAC group (CM + ECM/BMAC). All patients received Patient-Reported Outcomes Measurement Information System (PROMIS) surveys preoperatively and at minimum 1 year postoperatively. Postoperative complications were also noted for the patient cohort.

Results:

The average time from surgery to final follow-up was 21.6 (range, 12-36.2) months for CM patients and 27.8 (range, 12-82.5) months for CM+BMAC patients (P = .001). Both CM and CM+BMAC cohorts demonstrated significant improvement in physical function, pain interference, pain intensity, and global physical health. However, there were no significant differences in preoperative or postoperative PROMIS domains between the 2 cohorts.

Conclusion:

In conclusion, this study compares short-term patient-reported clinical outcomes and complications of cheilectomy and Moberg osteotomy against cheilectomy and Moberg osteotomy with ECM and BMAC for hallux rigidus. This study suggests that any potential differences in outcomes between groups are not large enough to be clinically meaningful in the short term and that other factors may be more relevant in determining the best course of treatment. A longer follow-up is required to evaluate long-term functional and clinical outcomes, and to see if addressing the cartilage has long-term effects.