Neo Angio-Osteo-Chonrogenesis Using Autologous Matrix induced Chondrogenesis (AMIC) Membrane in the Treatment of Freiberg`s Disease of Lesser Metatarsals –A Five Year Folow Up of 10 Cases

Category: Lesser Toes; Other Introduction/Purpose: Freiberg’s infraction is osteonecrosis of lesser metatarsal heads most commonly affecting adolescent females. They usually present with pain and swelling of the forefoot. MRI is useful investigation in the early diagnosis. It is a self-limiting disease and the main stay of treatment is non operative. Surgery is indicated in failed conservative management which include open debridement, cheilectomy, micro fracture, and osteotomy and excision arthroplasty. The aim of the study is to describe a new technique for treatment of Freiberg`s disease of lesser metatarsals and document the one and five-year functional outcomes. Methods: A retrospective analysis of ten patients who had Freiberg`s infraction of the lesser toe metatarsals treated with open debridement, microfracture, bone grafting and application of AMIC membrane was carried out. The patients were followed up to five years and the outcome measures were scored using The Manchester-Oxford Foot Questionnaire (MOxFQ) and Visual Analogue Pain Score (VAS), Figure 1. Results: The mean age was 42.7 years and follow-up time was 36.4 months. The most common site was second metatarsal, eight (80%) followed by third metatarsal, two (20%). The mean base line MOxFQ was 72.5 (95% CI- 45±100) which improved to 42.5 (95%CI- 2.5±82.5) at one year. The mean baseline VAS improved from 47.3(95%CI- 14.3±80.3) to 30.3 (95%CI- 2.1±58.5) at one year. The mean MOxFQ and VAS at five years was 7 (95%CI-0.8±13.2) and 3.6(95%CI-1.3±6.2) respectively. Conclusion: Open debridement of the Freiberg`s disease combined with microfracture of the defect, bone grafting and application of AMIC membrane gives good functional outcomes.