Percutaneous Tarsometatarsal Arthrodesis of the Lesser Ray with Autograft using a Cannulated Screw

CATEGORY: Midfoot/Forefoot INTRODUCTION/PURPOSE: Tarsometatarsal (Lisfranc) joint arthritis can be a painful condition caused by primary osteoarthritis, inflammatory, and posttrauma. When conservative treatment failed, tarsometatarsal arthrodesis is indicated. There has been no study on percutaneous tarsometatarsal arthrodesis previously. The purpose of this study is to report our percutaneous tarsometatarsal arthrodesis technique and the results of case series. METHODS: We report 11 joints from 6 feet with painful tarsometatarsal arthritis of lesser ray treated using percutaneous procedure using a wedge burr. The mean age at surgery was 67 years. The mean follow-up period was 12 months. Five feet of 4 patients had TMTj degeneration with hallux valgus. Another patient suffered from painful posttraumatic degenerative arthritis. Through 5-10 mm incision, a 2.9 mm-diameter wedge burr was introduced into the joint. Resection of subchondral bones was performed with the medial, lateral and plantar cortices preserved. The dorsal cortex except the burr insertion point was also remained. The iliac-crest bone grafts were taken using a 6-mm diameter trephine. Preoperatively and at the most recent follow-up visit, we applied the midfoot scale proposed by Japanese Society for Surgery of the Foot (JSSF). The validity and reliability of the JSSF scale has been confirmed in previous studies. RESULTS: Though there was one nonunion with screw breakage, we achieved successful results with no need of revision surgery during mean one year follow-up period. Bone unions were achieved in 10 of 11 joints (91%) at the most recent follow-up. JSSF midfoot scale significantly improved from 62 points preoperatively to 89.6 points at the most recent follow-up (p= 0.04). CONCLUSION: Our percutaneous TMTj arthrodesis was achieved a union rate and clinical results comparable to other surgical technique. This procedure was an effective method for treatment of TMTj arthritis.