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