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Modified Oblique Keller Capsular Interposition Arthroplasty for Hallux Rigidus.
JBJS Essent Surg Tech 2012; 2(1):e3JE

Abstract

Introduction

This paper describes the modified oblique Keller capsular interposition arthroplasty, which may be indicated for patients with late-stage hallux rigidus who wish to retain joint motion.

Step 1 Exposure

Make dorsal medial longitudinal incision over MTP joint and retract dorsal cutaneous nerve of great toe laterally.

Step 2 Mobilize Extensor Hallucis Longus Tendon

Separate extensor hallucis longus from dorsal aspect of capsule and extensor hallucis brevis and retract laterally.

Step 3 Mobilize Dorsal Aspect of Capsule and Extensor Hallucis Brevis Tendon

Leave inferior half of medial aspect of capsule attached to first metatarsal head to prevent late hallux valgus drift; make the capsular flap as long as possible.

Step 4 Perform Dorsal Cheilectomy and Resect Portion of Base of Proximal Phalanx to Decompress Joint

The greater the preoperative stiffness, the more bone needs to be removed from the phalanx base.

Step 5 Interpose Capsule and Suture Capsule to MTP Plantar Plate

Advance the dorsal aspect of the capsule over the metatarsal head and suture it into the plantar plate with absorbable suture in an interrupted fashion.

Step 6 Imbricate Medial Aspect of Capsule

Imbricate the medial aspect of the capsule with absorbable suture to hold the toe in a corrected position.

Step 7 Close Wound and Apply Supportive Dressing

Perform layered closure and apply forefoot compression dressing.

Step 8 Postoperative Care

Patient performs active range-of-motion exercises of great-toe MTP and IP joints, intrinsic muscle strengthening, and scar massage.

Results

We compared a cohort of patients who had the modified oblique Keller capsular interposition arthroplasty (MOKCIA) with a group who had an arthrodesis of the first MTP joint.

What to Watch For

IndicationsContraindicationsPitfalls & Challenges.

Authors+Show Affiliations

Center of Orthopedic and Rehabilitation Excellence, 3584 West 9000 South, Suite 405, West Jordan, UT 84088. E-mail address: rbmackey@hotmail.com.Barnes-Jewish Hospital at Washington University School of Medicine, St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31321126

Citation

Mackey, R Brian, and Jeffrey E. Johnson. "Modified Oblique Keller Capsular Interposition Arthroplasty for Hallux Rigidus." JBJS Essential Surgical Techniques, vol. 2, no. 1, 2012, pp. e3.
Mackey RB, Johnson JE. Modified Oblique Keller Capsular Interposition Arthroplasty for Hallux Rigidus. JBJS Essent Surg Tech. 2012;2(1):e3.
Mackey, R. B., & Johnson, J. E. (2012). Modified Oblique Keller Capsular Interposition Arthroplasty for Hallux Rigidus. JBJS Essential Surgical Techniques, 2(1), pp. e3. doi:10.2106/JBJS.ST.K.00030.
Mackey RB, Johnson JE. Modified Oblique Keller Capsular Interposition Arthroplasty for Hallux Rigidus. JBJS Essent Surg Tech. 2012;2(1):e3. PubMed PMID: 31321126.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modified Oblique Keller Capsular Interposition Arthroplasty for Hallux Rigidus. AU - Mackey,R Brian, AU - Johnson,Jeffrey E, Y1 - 2012/02/07/ PY - 2019/7/20/entrez PY - 2012/2/7/pubmed PY - 2012/2/7/medline SP - e3 EP - e3 JF - JBJS essential surgical techniques JO - JBJS Essent Surg Tech VL - 2 IS - 1 N2 - Introduction: This paper describes the modified oblique Keller capsular interposition arthroplasty, which may be indicated for patients with late-stage hallux rigidus who wish to retain joint motion. Step 1 Exposure: Make dorsal medial longitudinal incision over MTP joint and retract dorsal cutaneous nerve of great toe laterally. Step 2 Mobilize Extensor Hallucis Longus Tendon: Separate extensor hallucis longus from dorsal aspect of capsule and extensor hallucis brevis and retract laterally. Step 3 Mobilize Dorsal Aspect of Capsule and Extensor Hallucis Brevis Tendon: Leave inferior half of medial aspect of capsule attached to first metatarsal head to prevent late hallux valgus drift; make the capsular flap as long as possible. Step 4 Perform Dorsal Cheilectomy and Resect Portion of Base of Proximal Phalanx to Decompress Joint: The greater the preoperative stiffness, the more bone needs to be removed from the phalanx base. Step 5 Interpose Capsule and Suture Capsule to MTP Plantar Plate: Advance the dorsal aspect of the capsule over the metatarsal head and suture it into the plantar plate with absorbable suture in an interrupted fashion. Step 6 Imbricate Medial Aspect of Capsule: Imbricate the medial aspect of the capsule with absorbable suture to hold the toe in a corrected position. Step 7 Close Wound and Apply Supportive Dressing: Perform layered closure and apply forefoot compression dressing. Step 8 Postoperative Care: Patient performs active range-of-motion exercises of great-toe MTP and IP joints, intrinsic muscle strengthening, and scar massage. Results: We compared a cohort of patients who had the modified oblique Keller capsular interposition arthroplasty (MOKCIA) with a group who had an arthrodesis of the first MTP joint. What to Watch For: IndicationsContraindicationsPitfalls & Challenges. SN - 2160-2204 UR - https://www.unboundmedicine.com/medline/citation/31321126/Modified_Oblique_Keller_Capsular_Interposition_Arthroplasty_for_Hallux_Rigidus L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=31321126.ui DB - PRIME DP - Unbound Medicine ER -