Citation: Foot and ankle international. 2013, 34(8), 1158-67
Author: Ajis A, Seybold JD, Myerson MS
Abstract: BACKGROUND: Painful degenerative diseases of the metatarsophalangeal joints (MTPJs) are
frequently progressive and difficult to treat. Traditional operative treatments
such as debridement, distal metatarsal osteotomies, and arthroplasty present a
unique set of complications, and pain and deformity may still occur.
Osteochondral distal metatarsal allograft reconstruction (ODMAR) is presented as
a salvage procedure, reserved for patients with significant bone loss or
avascular necrosis in whom traditional interventions have failed or are
inadequate to address the underlying joint deformity. METHODS: A retrospective review identified all ODMAR cases performed by the senior
author over the past 10 years. Patient symptoms, satisfaction, and MTPJ range of
motion were measured at each postoperative evaluation. Graft healing and
subsequent degenerative changes at the MTPJ were observed at each visit with
foot radiographs. The surgical techniques for both first and lesser metatarsal
reconstructions are described. RESULTS: Six patients were identified with average follow-up interval of 36 months
(range, 6-66). Preoperative diagnoses included infection (1), fracture (1), and
avascular necrosis (4). Mean total arc of motion was 40 degrees (range, 30-50).
All patients maintained viability of the allograft metatarsal head and joint
space was normal or Kellgren-Lawrence grade 1 in 5 of 6 patients at final
follow-up. All patients demonstrated osseous union of the metatarsal osteotomy
site. No patients have undergone revision surgery to date. CONCLUSIONS: ODMAR is a safe and effective procedure for treatment of painful,
degenerative conditions of the MTPJs. Further studies are required to determine
the definitive indications and long-term outcomes for this procedure. LEVEL OF EVIDENCE: Level IV, retrospective case series. KEYWORDS: allograft, arthritis, forefoot disorders, metatarsal, necrosis, osteochondral
