Cheilectomy, Osteotomy, Microfracture, and Matrix-Induced Chondrogenesis (COMM): A Novel Combined Procedure for Treating Hallux Rigidus

Background Hallux rigidus (HR) is a degenerative joint disorder of the first metatarsophalangeal joint (MTPJ), causing joint pain and stiffness. Surgical treatments, including cheilectomy, microfracture (MF) and dorsal oblique osteotomy (DOO), have been well described in current literature. However, the addition of matrix-induced chondrogenesis (MIC) via scaffold implantation with bone marrow aspirate concentrate (BMAC) is novel and hypothesized to significantly improve cartilage healing. Objectives This study aimed to (1) describe the COMM procedure—a novel combination of cheilectomy, DOO, MF, and MIC, as well as to (2) evaluate its early clinical outcomes in a series of 12 HR cases. Study Design & Methods This is a retrospective study of 11 patients (12 feet) with HR treated with the COMM procedure in our hospital from May 2022 to June 2023 by 3 fellowship-trained foot and ankle surgeons. All the patients have completed their 1-year clinical review, where we evaluated their Numeric Pain Rating (NPR), European Foot and Ankle Society (EFAS), and Short Form-36 (SF-36) scores (Physical Function [SF-PF] and Mental Health [SF-MH]), as well as satisfaction. Preoperative and postoperative scores were compared to determine the effect of treatment. Results There was statistically significant improvement in all scores ( P < 0.05). EFAS Foot and/or Ankle and Sports scores improved from 9.3 to 20.0 and 3.8 to 9.4, respectively. SF-PF and SF-MH scores improved from 47.9% to 67.9% and 54.0% to 66.0%, respectively. Mean NPR at rest and during activity improved from 4.8 to 0.2 and 7.6 to 2.5, respectively. The mean postoperative satisfaction was 8.0, with 10 representing maximal satisfaction. Conclusions Despite being a small series, our study has shown good clinical outcomes and promising satisfaction rates among all patients who have undergone our COMM procedure.