Fusion of the Second Metatarsocuneiform Joint for the Painful Osteoarthrosis

Abstract

Background: Osteoarthrosis of the second metatarsocuneiform joint presents as pain, stiffness and osteophytic thickening of the midfoot. This study sought to determine the effectiveness and outcome of surgical fusion of osteoarthritic second metatarsocuneiform (MC) joint. The association between the condition and second metatarsal length was also explored. Materials and Methods: A series of 23 patients (22 female) of average age 58 years (SD 4.9) underwent second MCJ fusion and were reviewed at an average of 42 months (SD 19.5) postoperatively. The second MC joint fusion involved resection of the joint surfaces and internal fixation with a 3-hole 2.7-mm plate. A variety of graft materials were utilized. Results: The AOFAS midfoot rating scale score rose from a preoperative mean of 47 (SD 13) to a mean 90.5 (SD 12.5) postoperatively, p < 0.0001. Seventeen patients (74%) were completely satisfied. Four patients (17%) were satisfied with reservations. Two patients (9%) were dissatisfied. Twenty-one patients (91%) considered that they were better than before the operation and two patients were no better. Nonunion occurred in three patients and internal fixation was removed in four patients. One patient went onto develop osteoarthrosis in the third MC joint. We could not establish a causal relationship between osteoathrosis of the second MC joint and second metatarsal length. Conclusion: Fusion of the second MCJ is a moderately effective treatment for osteoarthrosis of the joint. In this series of patients, 74% were pain-free and nonunion was the most serious complication encountered, no patient was made worse by surgery.Level of Evidence: IV, Retrospective Case Series