Our experience with surgical treatment of Freiberg – Köhler disease using a collagen membrane allograft

Introduction. Freiberg–Köhler disease is a rare form of osteochondropathy of the second metatarsal head characterized by avascular necrosis, destruction of the articular surface, and secondary osteoarthritis. The disease predominantly affects adolescent and young adult females and is accompanied by severe pain, limited mobility, and foot deformity. Even with early diagnosis, conservative treatment is often insufficient to prevent disease progression, making surgical intervention necessary.

Aim: To evaluate the effectiveness of the collagen membrane Chondro-Scaffold in the surgical treatment of Freiberg–Köhler disease.

Object and methods. A retrospective analysis of clinical data from 28 patients was performed to assess the effectiveness of a technique combining shortening osteotomy and implantation of the Chondro-Scaffold collagen membrane using functional (AOFAS and VAS) and radiographic parameters. Postoperative follow-up was carried out at 3, 6, and 12 months.

Results. The use of the Chondro-Scaffold collagen membrane resulted in a significant improvement in foot function, as demonstrated by an increase in the AOFAS score from 46.2 to 89.5 and a decrease in pain intensity from 7.6 to 1.5 according to the VAS scale.

Conclusion. The use of the Chondro-Scaffold collagen membrane is a promising approach in the surgical treatment of Freiberg–Köhler disease, leading to improved clinical and functional outcomes and enhanced patient quality of life. Further studies are required to evaluate long-term effectiveness. 

1. 1 Gudi S.M., Luchshev M.D., Kuznetsov V.V., et al. Freiberg-Köhler disease: clinical manifestations, diagnostics, and treatment (literature review). Genij Ortopedii. 2022;28(3):431-443. (In Russ.) https://doi.org/10.18019/1028-4427-2022-28-3-431443

2. 2 Oliveira D, Costa L, Vaz C. Freiberg disease: A rare cause of chronic foot Reumatol Clin (Engl Ed). 2023;19(6):348-356.

3. 3 Smillie IS. Treatment of Freiberg's infraction. Proc R Soc Med. 1967;60(1):29-31. https://doi.org/10.1177/003591576706000117

4. 4 Freiberg AH. Infraction of second metatarsal bone. Atypicalinjury. Surg Gynecol Obstet. 1914;19:191.

5. 5 Schade VL. Surgical management of Freiberg’s infraction: a systematic review. Foot Ankle Spec. 2015;8(6):498–519.

6. 6 Seybold JD, Zide JR. Treatment of Freiberg Disease. Foot Ankle Clin. 2018;23(1):157-169. https://doi.org/10.1016/j.fcl.2017.09.011

7. 7 Trnka HJ, Lara JS. Freiberg's Infraction: Surgical Options. Foot Ankle Clin. 2019;24(4):669-676. https://doi.org/10.1016/j.fcl.2019.08.004

8. 8 Alhadhoud MA, Alsiri NF, Daniels TR, et al. Surgical interventions of Freiberg's disease: A systematic review. Foot Ankle Surg. 2021;27(6):606-614. https://doi.org/10.1016/j.fas.2020.08.005

9. 9 Liu Y, Ma N, Zhao Z. Mid- to Long-Term Clinical Outcomes of Cartilage Restoration of Knee Joint with Allogenic Next-Generation MatrixInduced Autologous Chondrocyte Implantation (MACI). Orthop Surg. 2023;15(2):549-562.

10. 10 Ajis A, Seybold JD, Myerson MS. Osteochondral distal metatarsal allograft reconstruction: a case series and surgical technique. Foot AnkleInt. 2013;34:1158–67

11. 11 Richter M, Zech S, Meissner SA, et al. Autologous matrix induced chondrogenesis plus peripheral blood concentrate (AMIC+PBC) in chondral defects of the first metatarsophalangeal joint – 5-year follow-up. Foot Ankle Surg. 2022;28(8):1366-1371. https://doi.org/10.1016/j.fas.2022.07.002

12. 12 Airapetov G.A., Vorotnikov A.A. Replacement of osteochondral defects of large joints. Innovative Medicine of Kuban. 2019;14(2):58-67.

13. 13 Airapetov G.A., Vorotnikov A.A., Vasyukov V.A. et al. Regenerative potentials of platelet-rich plasma in the treatment of focal osteochondral defects of the knee joint after microfracturing in an experiment. Practical Medicine. 2022;4(20):133-140.

14. 14 Nurmukhametov M.R., Makarov M.A., Byalik E.I., et al. Use of chondroplasty of the first metatarsophalangeal joint using the technique of autologous matrix-induced chondrogenesis for the treatment of patients with hallux rigidus: immediate results. Scientific and practical rheumatology. 2020;58(1):97–101.

15. 15 Okutan AE, Ayas MS, Öner K, et al. Metatarsal Head Restoration With Tendon Autograft in Freiberg's Disease: A Case Report. J Foot Ankle Surg. 2020;59(5):1109-1112. https://doi.org/10.1053/j.jfas.2019.06.010

16. 16 Vasyukov V.A., Vorotnikov A.A., Airapetov G.A., Chekrygin S.Yu. Efficiency of microfracturing with the introduction of platelet-rich plasma in the treatment of osteochondral defects in an experiment. Bulletin of the Smolensk State Medical Academy. 2022;3(21):18-26.

17. 17 Peras M, Peras M, Bilichtin E, et al. Results of the AMIC® method in patients operated on for an osteochondral lesion of the talar dome (OLTD) at a mean follow-up of 34 months. A retrospective multicenter study. Orthop Traumatol Surg Res. 2024;14:104-120.

18. 18 Kim SJ, Park JH, Kim GL. Comparison of osteochondral autologous transplantation and dorsiflexion closing wedge metatarsal osteotomy for late stage Freiberg disease in adults. Foot Ankle Int. 2020;41(5):529-535.

19. 19 Abdul W, Hickey B, Perera A. Functional outcomes of local pedicle graft interpositional arthroplasty in adults with severe Freiberg disease. Foot Ankle Int. 2018;39(11):1290–300.

20. 20 Ikoma K, Maki M, Kido M, et al. Extra-articular dorsal closing-wedge osteotomy to treat late-stage Freiberg disease using polyblend sutures: technical tips and clinical results. Int Orthop. 2014;38(7):1401-5. https://doi.org/10.1007/s00264-014-2381-3