Disclosures/Conflicts There were no grants No Disclosures as - PowerPoint PPT Presentation

5/8/2014 Disclosures/Conflicts � There were no grants � No Disclosures as related to this talk � There were no potential conflicts of interest. Introduction But… � Characterization of OCD in hallux valgus? � Hallux valgus deformity common � Correlation of cartilage lesions to � (Bock et al. JBJS Br 2004, Roukis et al. JFAS 2005) patient symptoms/outcome? � 15-20% dissatisfaction rate after hallux valgus correction � Correlation of cartilage lesions to (Smith et al. FA 1984, Coughlin et al. JBJS Am 2007) � severity of deformity? � 1 st MTP joint lesions have been associated with hallux � Prospective evaluation lacking valgus deformities � (Bock 2004, Lui 2008, Roukis 2005) 1

5/8/2014 Goals Hypothesis � Detail articular erosion patterns � Lesion grade and surface area would correlate with radiographic � Evaluate if damage is associated with measures of deformity and deformity patient clinical outcomes � Prospectively evaluate effect on outcomes Materials/Methods • Inclusion: � Exclusion: • Isolated pain � Rheumatoid • Hallux valgus � Inflammatory arthropathy • Refractory to non-op � Traumatic origin � Revision � DM � neuropathy 2

5/8/2014 Methods: Radiographic Methods: Clinical Outcomes Outcomes VAS � � Traditional Walking tolerance � Angles: HVA, IMA, HVIP, � Subjective numbness � DMMA AOFAS � � Grading- Grading- International � Cartilage Repair Society � (Coughlin (JBJS scale Am 2003) Location � � (Roukis et al. JFAS 2005) Pearson’s correlation coaefficient, student t-test, Post hoc power analysis- 44 would provide 90% power Often these are below the “equator” Results and not actually seen during bunion surgery � 56 feet � 91% with lesions � At 24 months: � VAS 5 � 1, AOFAS 59 � 89 � HVA 24 � 9, IMA 14 � 5 � 1 reoperation to fusion *Mean area 50 mm2 *Avg grade 3 *80% were inferior > superior, medial > lateral *size/grade did not correlate w/age or differ by gender 3

5/8/2014 Hallux valgus As oppose to Hallux rigidus DORSAL 4

5/8/2014 lesion max grade/number of lesions vs. radiograph outcomes lesion max grade/number of lesions vs. lesion max grade/number of lesions vs. radiograph outcomes radiograph outcomes 5

5/8/2014 lesion area vs radiographic outcomes lesion area vs radiographic outcomes 6

5/8/2014 Conclusions Discussion � Roukis et al. (JFAS 2005) � Proposed map • OCD in Hallux Valgus are anterior/medial/inferior � 100% w/ lesions >50 yo • No Correlation � Realign in young – High prevalence? � Lui et al. (Arthroscopy 2008) – Pain Multifactorial? � Correlated HVA to prevalence of OCD of 1 st MTP – Evaluation sensitive enough? • Significance of these lesions is unknown � Doty et al. (FAI 2013) • fusion or chondral repair techniques needed? � Cadeveric study- ant/inf > superior lesions • Not poor prognostic factors � More zones, higher grade of lesions • Realignment procedures are not contra-indicated � Correlated grade/size to angular deformity Thank You 7