Arthroscopic Autologous Bone Grafting for Hallux Sesamoid Fracture Nonunion Results in a High Rate of Complete Resolution

PURPOSE: To review the outcomes of patients with hallux sesamoid fracture nonunion who underwent arthroscopic autologous bone grafting. METHODS: Medical records of patients who underwent surgery between July 2017 and April 2020 were reviewed. The inclusion criterion was 2 years or more of follow-up. The exclusion criterion was less than 2 years of follow-up. Outcomes were assessed using the visual analog scale (VAS) for pain and the Japanese Society for Surgery of the Foot (JSSF) score. Improvements after surgery were analyzed using the Wilcoxon signed-rank test. RESULTS: Eleven patients (3 women and 8 men) were enrolled. The mean age was 18.6 years (standard deviation [SD] ± 10.3 years), and the mean body mass index was 21.9 kg/m(2) (SD ± 2.5 kg/m(2)). The mean follow-up duration was 3.2 years (SD ± 0.8 years). One patient had fracture nonunion in the fibular sesamoid and a hypoplastic tibial sesamoid. Another patient had fracture nonunion in the distal part of the congenital bipartite sesamoid. The other patients had fracture nonunion in the normal tibial sesamoids. The mean duration until bone union was 2.9 months (SD ± 0.8 months). The mean duration until returning to sports was 5.3 months (SD ± 3.6 months). The VAS score improved from 72.1 (SD ± 15.2) preoperatively to 12.0 (SD ± 26.7) postoperatively. The JSSF score improved from 58.7 (SD ± 15.8) preoperatively to 95.0 (SD ± 11.0) postoperatively (P < 0.01, respectively). All patients except the two previously described achieved a VAS score of 0 and a JSSF score of 100 postoperatively. The remaining 2 patients with congenitally distinct sesamoids and fractures had poor outcomes. No complications were observed. CONCLUSIONS: Nine of the 11 patients reported complete resolution. The remaining two patients with congenitally distinct sesamoids and fractures had poor outcomes.