Osteochondral reconstruction of the first metatarsophalangeal joint in rheumatoid arthritis using autograft harvested during a modified Lapidus procedure: a case report
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ID: 313502
2026
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Abstract
Reconstruction of the severely destroyed first metatarsophalangeal (MTP) joint in patients with rheumatoid arthritis (RA) remains challenging, and arthrodesis is commonly selected as the standard procedure. We describe a novel surgical technique that reconstructs the destroyed first MTP joint by repurposing osteochondral fragments harvested during a modified Lapidus procedure without additional donor-site morbidity. A 57-year-old woman with long-standing RA presented with severe destruction of the first MTP joint associated with a complex forefoot deformity. Following a modified Lapidus procedure and lesser metatarsal shortening, osteochondral grafts harvested from the first tarsometatarsal joint were used to anatomically restore the first MTP joint. The distal medial cuneiform fragment was used to reconstruct the first metatarsal head, and the proximal first metatarsal fragment was used for the proximal phalanx, allowing bilateral joint resurfacing. All grafts were secured with absorbable pins. Postoperative radiographs at one year demonstrated maintained alignment, joint congruity, and stable graft incorporation without complications. The patient reported marked pain relief and improved ambulatory function while preserving MTP joint motion. This biological recycling technique can provide a viable option for reconstructing destroyed articular surfaces in carefully selected RA cases without donor-site morbidity.
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| Authors | Dan Moriwaki, Tomoyuki Nakasa, Yasunari Ikuta, Saori Ishibashi, Satoru Sakurai, Taro Chujo, Nobuo Adachi |
| Journal | Modern Rheumatology Case Reports |
| Year | 2026 |
| DOI |
10.1093/mrcr/rxag034
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| URL | |
| Keywords | Keywords not found |
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