Abstract
Category:
Midfoot/Forefoot; Other
Introduction/Purpose:
The purpose of this systematic review was to evaluate outcomes following surgical intervention for osteochondral lesions of the 1st metatarsal head.
Methods:
During February 2024, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following surgical intervention for the management of osteochondral lesions of the 1st metatarsal head. Data regarding study characteristics, patient demographics, subjective clinical outcomes, radiological outcomes, complications, and failure rates were extracted and analyzed. In addition, the level of evidence and quality of evidence for each individual study was also assessed. Fifteen studies were included.
Results:
In total, 324 patients (367 metatarsal) underwent surgical intervention for a 1st metatarsal OCL at a weighted mean follow-up time of 32.1±9.2 months. The mean lesion size was 52.3 ± 8.4 mm2. The most common procedure was osteochondral autograft in 123 cases (19.4%). Other procedures performed included subchondral drilling, particulated juvenile cartilage allograft, osteochondral mosaicplasty, microfracture and anterograde drilling. There were statistically significant improvements in subjective clinical outcomes across all surgical techniques. The overall complication rate was 2.2%, the most common of which was persistent pain (1.5%). There were 29 failures (8.9%) all of which warranted a further surgical procedure.
Conclusion:
This systematic review demonstrated that osteochondral lesions of the 1st metatarsal head are an uncommon pathology with no consensus regarding the optimal treatment strategy. The most common surgical procedure (osteochondral autograft) restores the osteochondral unit, leading to excellent clinical outcomes at final follow-up. Microfracture destroys the subchondral plate and produces inferior quality fibrocartilage, thus should not be recommended.