Abstract
Category:
Midfoot/Forefoot
Introduction/Purpose:
Sesamoidectomy is most often indicated for sesamoid fractures. The procedure may also be a useful option for cases of recalcitrant sesamoiditis, osteochondritis dissecans, and osteoarthritis. In instances of concomitant arthritis of the first metatarsophalangeal joint and the sesamoids, sesamoidectomy may be performed in tandem with first metatarsophalangeal joint fusion. This carries the additional benefit of harvesting bone graft from the excised sesamoid to include in the fusion construct.
Though sesamoidectomy is commonly performed through a medial or plantar approach, neither of these approaches are suited to fusion of the first metatarsophalangeal joint. Sesamoidectomy can be performed effectively through a dorsal approach and is the preferred technique when performed in conjunction with first metatarsophalangeal joint fusion.
Methods:
A dorsal midline incision is made over the first metatarsophalangeal joint. Care is taken to protect the extensor hallucis longus tendon while dissection proceeds to the joint capsule. The capsule is incised and released so that the first metatarsophalangeal joint can be sufficiently mobilized. Next, the opposing joint surfaces are prepared, increasing the mobility of the joint and exposure of surrounding structures.
Results:
(technique, continued) A sharp retractor is used to elevate the metatarsal head. Hyperflexion of the metatarsophalangeal joint may increase visualization of the sesamoids. A fresh knife is used to tease the sesamoid away from the flexor hallucis longus tendon, beginning at one edge of the sesamoid. The bone is carefully elevated off the tendon while dissection proceeds around the perimeter. Once the sesamoid has been freed and excised, the tendon is examined for injury.
The excised sesamoid can then be cleared of soft tissue and cartilage and morselized for bone graft.
Conclusion:
The dorsal approach is effective for sesamoidectomy and efficient when performed as an adjunct to first metatarsophalangeal joint fusion.