Arthroscopic sesamoidectomy for managing stress fractures of the medial great toe sesamoid in adolescent athletes: two case reports and review of the literature

Abstract

Sesamoid bone injuries of the first metatarsophalangeal joint are rarely encountered. Nonetheless, these injuries seem to occur more frequently in sports active population, thus affecting adolescents and younger people, particularly gymnasts, dancers, and track and field athletes. Patients are experiencing pain in the plantar aspect of the first metatarsophalangeal joint, which is aggravated while walking, running or jumping. Diagnosing sesamoid bone disorders relies on careful history taking, detailed physical examination and radiographic imaging such as x-rays and magnetic resonance imaging. Reduced weight bearing of the first metatarsophalangeal joint is the basis of conservative treatment of these injuries. However, such treatment offers limited success rates for return to sports at the patient’s previous level of activity. Therefore, in most cases, surgical management is recommended. The sesamoid bones can be completely or partially excised, performing sesamoidectomy either by open surgery or using arthroscopy. This paper brings two case reports detailing partial and total arthroscopic sesamoidectomy due to medial sesamoid bone stress fracture of the first metatarsophalangeal joint. It includes comprehensive description of surgical techniques and postoperative rehabilitation, emphasizing that both athletes have returned to their previous level of sporting activity. Key words: SESAMOID BONES; FRACTURES, BONE; ARTHROSCOPY