Cadaveric Evaluation of First Tarsometatarsal Joint Arthrodesis Joint Preparation Using a Single versus Double Portal Approach with a 3.0 mm MIS Burr.

Abstract

The first tarsometatarsal joint (TMTJ) arthrodesis is a common, reproducible procedure performed for severe hallux valgus correction and first TMTJ arthritis. As technology innovations evolve, minimally invasive surgery (MIS) is becoming popular and starting to be utilized for first TMTJ arthrodesis. The purpose of this study was to evaluate the efficacy of first TMTJ preparation using a 3.0 mm MIS burr through a single versus double portal approach. Additionally, we evaluated surrounding soft tissue structures at risk for iatrogenic injury. This was an anatomic study comprised of 17 cadaveric specimens. Preparation of the first TMTJ was performed through a single portal for all right specimens and a double portal for all left specimens using a 3.0 mm burr for two-minutes. The specimens were then dissected and surrounding soft tissue structures were evaluated. After joint disarticulation, the cartilage resection surface area ratios were evaluated. The total medial cuneiform and first metatarsal base ratio was 64.80% and 70.71% respectively. There was no significant difference in cartilage debridement of the medial cuneiform (P = 0.33) or first metatarsal base (P = 0.35) in the single versus the double portal group. No damage to the extensor hallucis longus (EHL) nor medial dorsal cutaneous nerve (MDCN) was noted. In conclusion, the authors believe that with adequate time and experience, successful joint preparation of the first TMTJ can be achieved using both a single or double portal approach with minimal iatrogenic risk to surrounding soft tissue and neurovascular structures.