title: Late-stage Freiberg disease treated by osteochondral plug transplantation: a case series.
abstract: BACKGROUND
  The purpose of this study was to investigate the clinical, radiological and arthroscopic results of osteochondral plug transplantation for late-stage Freiberg disease.
  
  
  METHODS
  We examined 4 consecutive cases of late-stage Freiberg disease of the second metatarsal head. All 4 patients were female with an average age of 12. Osteochondral plug transplantation was performed, harvesting from a nonweightbearing site of the upper lateral femoral condyle of the ipsilateral knee. Clinical evaluation using the American Orthopaedic Foot and Ankle Society (AOFAS) Lesser Metatarsophalangeal-Interphalangeal Scale was performed before surgery and at the final followup. Magnetic resonance imaging (MRI) was performed before surgery and at 6 and 12 months after surgery. Furthermore, arthroscopic evaluation was performed at 12 months after surgery. The mean follow up was 52 (range 36 to 72) months.
  
  
  RESULTS
  At the final follow up, the average AOFAS score improved from 70.8 points preoperatively to 97.5 points. Although MRI at 6 months after surgery showed an obvious but slight osteochondral plug-subchondral bone interface, healing of the osteochondral plug was confirmed at 12 months after surgery in all patients. With respect to the patients' arthroscopic findings at 12 months after surgery, two of our patients had an International Cartilage Repair Society Cartilage Repair Assessment Score of normal and 2 had a score of nearly normal.
  
  
  CONCLUSIONS
  Osteochondral plug transplantation for late-stage Freiberg disease yielded satisfactory results upon arthroscopic and radiological evaluations at 12 months after surgery and clinical evaluation for all four cases.
authors.affiliation: Department of Orthopaedic Surgery, Shimane University School of Medicine, 89-1, Enya, Izumo, Shimane 693, Japan. miyamoto@med.shimane-u.ac.jp
authors.forename: Wataru
authors.initials: W
authors.lastname: Miyamoto
authors.forename: Masato
authors.initials: M
authors.lastname: Takao
authors.forename: Yuji
authors.initials: Y
authors.lastname: Uchio
authors.forename: Taisuke
authors.initials: T
authors.lastname: Kono
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Ochi
mesh_terms: D000293:Adolescent; D001847:Bone Diseases / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D002357:Cartilage Diseases / Q000601:surgery*; D002358:Cartilage, Articular / Q000637:transplantation*; D002648:Child; D005260:Female; D006801:Humans; D008682:Metatarsal Bones / Q000601:surgery*