CME OnDemand: 2022 AOFAS Annual Meeting-Tarsometatarsal Joint Preparation using a Modified Dorsal Approach vs Standard Approach: A Cadaver Study

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In this cadaveric study, the researchers compared the standard dorsal approach to the modified single dorsal approach for preparation of the tarsometatarsal (TMT) joint in foot injuries. The goal was to evaluate the total surface area of the joint that could be prepared for primary arthrodesis of the TMT. <br /><br />The study involved 10 below-knee cadavers randomly assigned to either the standard or modified approach. The joint surface was prepared as for joint fusion, and the TMT joint was disarticulated and photographed for analysis. Blinded reviewers measured the articular joint surface using ImageJ analysis.<br /><br />The results showed no significant difference in the amount of joint prepared between the two approaches for the first three TMT joints. The percentages of total joint prepared were similar for both approaches.<br /><br />Strengths of the study included the involvement of fellowship trained foot and ankle surgeons and the use of blinded reviewers to eliminate bias. However, there were also weaknesses such as the small sample size, which limited the ability to derive statistical significance. Individual surgeon skill and the inherent tissue malleability in cadaver studies may have also influenced the results. Additionally, patient-reported outcomes were not assessed.<br /><br />The study suggests that the modified single dorsal approach may provide comparable joint preparation for primary arthrodesis as the standard approach. It may have advantages in terms of avoiding skin bridges, reducing skin necrosis, and minimizing iatrogenic soft-tissue injury. The authors propose that the modified approach could alleviate soft tissue complications while still enabling effective joint preparation. Figures 1, 2, and 3 in the document illustrate the standard and modified approaches and the ImageJ analysis of the TMT joint area prepared.<br /><br />In summary, this cadaveric study found that the modified single dorsal approach provided comparable joint preparation for primary arthrodesis of the TMT joint compared to the standard dual incision approach. The modified approach may have advantages in terms of minimizing soft tissue complications. However, further research with larger sample sizes and evaluation of patient outcomes is needed to confirm these findings.

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Ashish Shah, MD, Sudarsan Murali, MBA, Zachary Littlefield, Sean M. Young, David A. Patch, MD, Roshan Jacob, Kevin S. Luque-Sanchez, Logan Reed, Joseph Elphingstone

Keywords

cadaveric study

dorsal approach

modified single dorsal approach

tarsometatarsal joint

foot injuries

primary arthrodesis

joint preparation

ImageJ analysis

soft tissue complications

patient outcomes