Is Arthroscopic Surgery Favorable for Freiberg’s Disease in Metatarsophalangeal Joint?

CATEGORY: Arthroscopy; Midfoot/Forefoot INTRODUCTION/PURPOSE: Freiberg's disease is osteochondrosis involving the metatarsal heads. It is a rare disease, mostly found in the second or third metatarsal. The surgical treatment regimens for this disease have not yet been completely defined. We report the outcomes of cases of Freiberg's disease treated with arthroscopic surgery. To assess the effectiveness of a minimally invasive procedure with arthroscopic surgery for the treatment of Freiberg's disease. METHODS: From 2015 to 2019, 13 patients (15 feet) diagnosed with Freiberg's disease were enrolled for arthroscopic surgery. Patients were divided based on the Smillie's classification system; 2 stage I, 8 stage II, 3 stage III, 1 stage IV, and 1 stage V. Arthroscopic procedures included synovectomy, debridement, chondroplasty, microfracture, and loose body removal. For radiological evaluation, we obtained pre- and post-operative follow-up X-rays and MRIs. We evaluated clinical outcomes using the American Orthopaedic Foot & Ankle Society (AOFAS) lesser metatarsophalangeal (MTP)-interphalangeal score, and the Visual Analogue Scale (VAS) score. The MTP joint range of motion (ROM) was measured pre- and post-operatively. RESULTS: Radiological study showed no evidence of osteonecrosis progression in the post-operative follow-up X-ray images in any of the 15 cases. Postoperative 12-month MRIs showed reduction of bone-marrow edema, irregularity of subchondral bone, and cartilage defects in all cases. There were significant improvements in AOFAS scores and VAS scores at post-operative 2 weeks and 3 and 12 months over the pre-operative scores (p < 0.05). The MTP joint ROM improved at the last follow-up (p < 0.05). CONCLUSION: Arthroscopic surgery applied to Freiberg's disease showed excellent results regardless of grades (Smillie's classification system) in radiological evaluation, clinical outcomes, and MTP joint ROM. We suggest it as a treatment of choice for surgeons when they encounter Freiberg's disease.