Comparison of Clinical Outcomes Between Cheilectomy and Proximal Phalangeal Dorsiflexion Osteotomy with and without Bone Marrow Aspirate Concentrate and Particulated Cartilage for Hallux Rigidus

Category: Midfoot/Forefoot; Basic Sciences/Biologics Introduction/Purpose: Cheilectomy in conjunction with a proximal phalangeal dorsal closing wedge (Moberg) osteotomy is a popular strategy to manage early- to moderate-stage hallux rigidus. While the cheilectomy and Moberg osteotomy procedure has demonstrated good results, there are questions concerning how articular cartilage damage or an accompanying osteochondral lesion of the first MTP joint should be addressed, which could lead to persistent symptoms despite a technically well-performed operation. We propose that bone marrow aspirate concentrate (BMAC) combined with Biocartilage can be a viable adjunct that has demonstrated excellent outcomes in the treatment of OCLs in other joints. The purpose of this study was to compare clinical and patient-reported functional outcomes for patients who underwent cheilectomy and Moberg osteotomy with those who underwent cheilectomy and Moberg with BMAC. Methods: This was a single-center retrospective study conducted from the institutional review board-approved Foot and Ankle Registry data, and the protocol was approved by the steering committee at the investigators’ institution. Patients who received open cheilectomy with first proximal phalangeal dorsal closing wedge osteotomy with or without BMAC between 2016 to 2023. Inclusion criteria included patients aged 18 or older who underwent cheilectomy with Moberg osteotomy for a primary diagnosis of moderate to advanced hallux rigidus and had preoperative PROMIS scores. Excluded were patients without preoperative radiographs and patients with histories of previous ipsilateral forefoot surgeries, rheumatoid arthritis, or gout. Retrospective review of the registry was performed, and 137 patients were included. 71 treated with cheilectomy and Moberg osteotomy alone (CM) and 66 treated with cheilectomy and Moberg osteotomy with Biocartilage and BMAC (CMB). Results: Both CM and CMB cohorts demonstrated significant improvement in Physical Function, Pain Interference, Pain Intensity, and Global Physical Health. Preoperatively, there were no significant differences in PROMIS domains between the two cohorts. Postoperatively, there were no significant differences in PROMIS between the CM and CMB cohorts. There were no significant differences in the incidence of subsequent procedures on the ipsilateral first ray, revisions, conversions to first MTP arthrodesis, infections, progression to arthritis, and persistent pain. The rate of revision between the CM and CMB groups was not significantly different. Conclusion: This study compared short- to medium-term patient-reported clinical outcomes and complications of cheilectomy and Moberg osteotomy with and without BMAC for hallux rigidus. The addition of BMAC did not increase the incidence of postoperative complications while producing similar PROMIS scores at 1-year minimum followup. This study suggests that any potential differences in outcomes between groups are not large enough to be clinically meaningful in the short term and that other factors may be more relevant in determining the best course of treatment. A longer follow-up is required to warrant if the use of biologics in this procedure is necessary.