Saturday Disclosure Partner, BESPA Global Orthosolutions, Design - PowerPoint PPT Presentation

Saturday

Disclosure • Partner, BESPA Global • Orthosolutions, Design Team Member • ACFAS, Speaker

What is Decompression? • Grafting • Osteotomy • Cheilectomy

Decompression Indications/Contraindications ⦿ Indications ⦿ Indications • Healthy/Active Patient • Healthy/Active Patient • Cartilage Loss • Cartilage Loss ● Grade I to III ● Grade I to III • Want to retain motion • Want to retain motion ⦿ Contraindications • Grade IV • Shape of Metatarsal Head • Damaged Proximal Phalanx

Decompression Considerations ⦿ Patient Expectations ⦿ Patient Expectations ⦿ Underlying Etiology ⦿ Underlying Etiology • Met Primus Elevatus • Met Primus Elevatus • Parabola • Parabola • Shape of MT head • Shape of MT head ⦿ Typically dorsal 50% of ⦿ Typically dorsal 50% of articular surface is articular surface is damaged damaged

Surgical Technique ⦿ Patient Selection • Grade I to III • Has Decent Motion • Need to address underlying etiology • Adjunctive procedure ● Cheilectomy ● Decompression/Shortening osteotomy

Surgical Technique ⦿ Preoperative Considerations • Pt Foot Type ● Parabola • Amount of graft needed • Damage/Shape to Proximal Phalanx • Etiology

Surgical Technique ⦿ Options for Graft ⦿ Options for Graft ⦿ Decision on Graft • Autogenous • Autogenous • Medial Talar Head will produce limited graft ● Medial Talar Head ● Medial Talar Head • Multiple Small grafts from ● *Knee ● *Knee Fresh Metatarsal • Allogeneic • Allogeneic • Unlimited Supply of Synthetic ● Fresh Metatarsal ● Fresh Metatarsal Plugs • Alloimplants • Alloimplants ● Synthetic Plugs ● Synthetic Plugs

Surgical Technique ⦿ Prepping the Surface ⦿ Prepping the Surface • Cheilectomy • Cheilectomy ● Evaluate Articular ● Evaluate Articular Surface Surface ● How big is defect ● How big is defect ● Pre-op MRI? ● Pre-op MRI? ● Mosaicplasty with ● Mosaicplasty with 6/8/10 mm plugs 6/8/10 mm plugs

Surgical Technique ⦿ Prepping the Recipient Site • Guide Pin • Ream ● 6/8/10 ● 8mm deep

Surgical Technique ⦿ Harvest of articular Surface ⦿ Harvest of articular Surface • 6/8/10 mm plug resection • 6/8/10 mm plug resection • Trephine • Trephine ● 2mm deeper ● 2mm deeper • Multiple smaller plugs • Multiple smaller plugs advantageous advantageous • Mix and match based on • Mix and match based on articular surface articular surface

Surgical Technique ⦿ Transfer of Graft ⦿ Transfer of Graft • Placement • Placement • Left “Proud” • Left “Proud” • Tamped Flush • Tamped Flush ⦿ Mosaicplasty ⦿ Mosaicplasty • “Olympic Rings” • “Olympic Rings” • Contour of Articular • Contour of Articular Surface Surface

Surgical Technique ⦿ Address Etiology ⦿ Address Etiology • Elongated MT • Elongated MT ● Shortening Osteotomy ● Shortening Osteotomy ● Decompression is key ● Decompression is key • MPE • MPE ● Plantarflexory Osteotomy ● Plantarflexory Osteotomy ● Dual plane Chevron ● Dual plane Chevron ● Waterman-Green ● Waterman-Green

Surgical Technique

Surgical Technique ⦿ Post-operative ⦿ Post-operative Course Course • Early ROM of joint • Early ROM of joint • WB dependant upon • WB dependant upon ancillary procedures ancillary procedures ⦿ Donor Site ⦿ Donor Site • Bone Graft • Bone Graft

Limitations ⦿ No EBM • Knee/Ankle ● Axial Loading Joints ● MPJ differs • Different Etiology ● OCD vs. DJD ⦿ Case Reports • Both Traumatic ● Kravitz JFAS 2005 ● Zelent & Nees JFAS 2005

Take Home Points ⦿ Range of Motion ⦿ Watch the Parabola ⦿ Look at the Joint

Thank You