Arthroscopic Management of Disorders of the First MTP Joint, Perspective 3

Abstract

Arthroscopic surgery is one of the basic types of procedures in orthopedic surgery. In the 1980s, there was a drift toward performing arthroscopic procedures on smaller joints [1–4]. Although nowadays arthroscopic surgeries of the knee, shoulder, elbow, ankle, and wrist have become routine procedures, arthroscopy of the first metatarsophalangeal (MTP-I) joint has received scant attention [5] and has scarcely been reported in articles. Watanabe [1] was the first to describe an arthroscopic procedure of the big toe in 1986. In 1999, Frey et al. [6] reported that arthroscopic surgery of the MTP-I was still a developing procedure with a gray area for application. We published our first 27 MTP-I joint arthroscopic procedures in 1998, and, in a further publication, we reported the most important indications: osteochondral defect, dorsal impingement, and infectious arthritis [7]. Currently, we lack evidence based on long-term follow-up studies on arthroscopic surgery of the MTP-I joint. After all these years, the procedure is still considered investigational. Although the arthroscopic procedure of the MTP-I joint is technically feasible and amenable for arthroscopy, the procedure is dependent on the skills of the surgeon. In this chapter, we describe the basic anatomy of the joint, the indication, the arthroscopic procedure, and the outcome.