Cryopreserved Amniotic Membrane and Autogenous Adipose Tissue as an Interpositional Spacer After Resection of a Cubonavicular Coalition: A Case Report and Review of the Literature

doi:10.1053/j.jfas.2019.03.024

The Journal of Foot and Ankle Surgery

Volume 59, Issue 1, January–February 2020, Pages 173-177

https://doi.org/10.1053/j.jfas.2019.03.024 Get rights and content

Abstract

Coalitions of the hindfoot are a relatively rare but challenging condition encountered by foot and ankle surgeons. Those that manifest between the cuboid and navicular (cubonavicular coalitions) are seen even more infrequently and are estimated to comprise ∼1% of all tarsal coalitions. Treatment for cubonavicular coalitions parallels protocols for more common hindfoot coalitions. Typically, resection versus hindfoot arthrodesis procedures are used. The present study describes the case of a 34-year-old male with a painful cubonavicular coalition and early secondary signs of arthrosis. Despite the recommended guidelines of hindfoot arthrodesis, he elected for surgical resection. Autogenous adipose tissue and cryopreserved amniotic membrane were used for interposition at the resection site. This case demonstrates that surgical resection with interpositional grafting can be successful even in advanced disease states.

Section snippets

Case Report/Series

A 34-year-old male presented to the senior author's clinic with chronic aching pain localized to his left dorsolateral midfoot. His pain started ∼2 years prior with an insidious onset. He did acknowledge a heavy ambulatory demand for his job requirements as a warehouse laborer. He described the pain as dull and continuously aching, which progressed to severe sharp pain while ambulating and with extended periods of activity. At worst, he described his pain as a 7 of 10 on the visual analogue

Discussion

Tarsal coalitions result from abnormalities in differentiation in the first stages of development (14). A genetic correlation has been described as well as combined presentation of tarsal coalition with hereditary symphalangism and clinodactyly (15). Classic presentation of tarsal coalition is more common in males than in females and is often described by patients as progressive pain and stiffness in the midfoot and hindfoot (16). Clinically, midfoot and hindfoot range of motion is decreased.

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Cited by (4)

Cubonavicular Coalition: Magnetic Resonance Imaging Findings and Associated Pathology of a Rarely Reported Condition in 27 Patients
2024, Academic Radiology
(1) Describe multimodality imaging of cubonavicular coalition (CNC) with magnetic resonance imaging (MRI) focus, (2) evaluate CNC associated foot and ankle pathology, (3) examine clinical presentation/symptoms associated with CNC, (4) record CNC treatment.
Retrospective Institutional Review Board (IRB) approved study. Picture Archiving and Communication System (PACS) databases searched for CNC. Final study population: 34 cases in 27 patients. Each CNC was reviewed for: coalition type (osseous versus non-osseous- cartilaginous versus fibrous), tendon and ligament pathology, bone marrow edema at CNC and adjacent joints, presence and severity of degenerative changes at CNC and adjacent joints, fractures, additional coalitions, laterality, and pes planus. MRI planes and radiographic views on which coalitions were best identified were recorded. Each CNC EMR was reviewed for: symptoms, trauma, management, patient demographics. Inter-reader reliability was performed for type of non-osseous coalition.
Final cohort included 34 cases in 27 patients (average age: 34.7, range: 10–76; 71% female). No CNC was completely osseous. On MRI, 89.5% of coalitions were non-osseous and 5.3% were partially osseous. 76.5% of patients had referable symptoms including pain, limited motion, inability to bear weight. 23.5% of patients were surgically managed/pathologically proven. On MRI, 36.8% of patients had tendon pathology, 52.6% had ligamentous pathology, 100% had bone marrow edema-like signal abnormality about the CNC, and 88.2% had CNC degenerative changes. There was bone marrow edema-like signal abnormality at bones adjacent to the CNC in 52.6% and adjacent joint degenerative disease present in 50%. CNC was best identified on oblique radiographs and axial MRI. Inter-reader reliability for non-osseous coalition type was poor, Cronbach’s alpha 0.554.
CNC is subtle and findings of osteoarthritis or bone marrow edema-like about the cubonavicular articulation should raise suspicion for underlying coalition.
Incidental findings in sports imaging
2023, Journal of Arthroscopy and Joint Surgery
Standardized reporting of amnion and amnion/chorion allograft data for wound care
2022, Health Science Reports
A Review on Modifications of Amniotic Membrane for Biomedical Applications
2021, Frontiers in Bioengineering and Biotechnology

: Financial Disclosure: None reported.

: Conflict of Interest: None reported.

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Cryopreserved Amniotic Membrane and Autogenous Adipose Tissue as an Interpositional Spacer After Resection of a Cubonavicular Coalition: A Case Report and Review of the Literature

Abstract

Section snippets

Case Report/Series

Discussion

Radiol Clin North Am

Rev Brasil Ortop (English Edition)

Orthop Traumatol Surg Res

J Foot Ankle Surg

Clin Podiatr Med Surg

Clin Podiatr Med Surg

Congenital tarsal coalition: multimodality evaluation with emphasis on CT and MR imaging

Radiographics

Tarsal coalition

Partial cubo-navicular coalition as a cause of peroneal spastic flat foot

J Bone Joint Surg

Cubonavicular coalition

J Am Podiatr Med Assoc