Plantar Plate Repair of the Metatarsophalangeal Joint through a Dorsal Approach, Early Clinical Results with a Minimum follow-up of 12 Month

Instability of the lesser metatarsophalangeal joint can lead to severe metatarsalgia. Recent research has focused on reconstruction of the plantar plate to restore normal function of the affected joint and toe.

In a 2 year period between December 2012 and December 2014 27 reconstruction of the plantar plate of a lesser metatarsophalangeal joint in 25 feet were performed in the authors institution using the Arthrex Complete plantar plate repair system. The procedure includes a Weil-Osteotomie and a (re)fixation of the plantar plate to the phalangeal base with 2 fibre-wire sutures.

Clinical and radiologic follow-up date were collected in 21 of the 25 patients (84%) leaving 23 reconstruction procedures for analysis.

Mean age of the 19 women and 2 men at the operation was 64,5,+/-,6,6, (50-76) years.

Praeoperative clinical evaluation showed 10 dislocation and 13 severe instabilities of the metatarsophalangeal joint.

Intraoperative Evaluation of type and extension of the plantar plate rupture was performed. The amount of detachment of the plantar plate from the base of the phalanx was 71.9 +/- 20 (50- 100) % on average.

Clinical and radiological follow-up was obtained after 18,6, +/- 5,7 (12-30) month.

The AOFAS Score improved significantly from 48.6 +/- 19.5 (20 – 82) points to 88.1 +/- 17.5 (64 – 100) points (p< 0,01).

A total of 5 re-dislocations were observed

Function of the toe and metatarsophalangeal joint with assessed using the “toe-purchase-test”. A strong plantarflection of the toe was seen in 13 toes a week plantarflection was seen in 3 toes and no plantarflection was seen in 7 toes.

Conclusion: Complete planatar plate repair of a lesser metatarsophalangeal joint allows reconstruction of dislocated or severly instable lesser metatarsophalangeal joint. Good clinical function of the toe can be achieved in the majority of patients. Nevertheless re-dislocation Is still of concern leading to the question how to optimize the procedure so that a lasting fixation of the detached plantar plate to the phalangeal base can be achieved.