Plantar plate repair of the second metatarsophalangeal joint: Technique and tips

Abstract

Since diagnostic arthrography of the second metatarsophalangeal joint (MTPJ) has been popularized by Karpman and MacCollum ( 1 Karpman R.R MacCollum III, M.S Arthrography of the metatarsophalangeal joint. Foot Ankle. 1988; 9: 125-129 Crossref PubMed Scopus (13) Google Scholar ), the relationship between plantar plate integrity and digital instability is better understood. Yao et al ( 2 Yao L Do H.M Cracchiolo A Farahani K Plantar plate of the foot findings on conventional arthrography and MR imaging. AJR Am J Roentgenol. 1994; 163: 641-644 Crossref PubMed Scopus (75) Google Scholar ) suggested that an arthrogram of the second MTPJ exhibiting opacification of the flexor tendon sheath is pathognomonic for a plantar plate tear. The plantar plate is the principal stabilizer of the MTPJ and any compromise to its integrity creates instability to the joint ( 3 Coughlin M.J Second metatarsophalangeal joint instability in the athlete. Foot Ankle. 1993; 14: 309-319 Crossref PubMed Scopus (95) Google Scholar , 4 Coughlin M.J Subluxation and dislocation of the second metatarsophalangeal joint. Orthop Clin North Am. 1989; 20: 535-551 PubMed Google Scholar , 5 Coughlin M.J Lesser toe deformities. Orthopedics. 1987; 10: 63-75 PubMed Google Scholar ). The plantar plate stabilizes the lesser toes via the plantar fascia windlass mechanism. Insufficiency of the plantar plate is implicated in the pathogenesis of chronic MTPJ and toe subluxation/dislocation. Primary repair of the plantar plate has been gaining attention recently and has been advocated for tears or ruptures that result in instability to the MTPJ ( 6 Ford L.A Collins K.B Christensen J.C Stabilization of the subluxed second metatarsophalangeal joint flexor tendon transfer versus primary repair of the plantar plate. J Foot Ankle Surg. 1998; 37: 217-222 Abstract Full Text PDF PubMed Scopus (101) Google Scholar , 7 Powless S.H Elze M.E Metatarsophalangeal joint capsule tears an analysis by arthrography, a new classification system and surgical management. J Foot Ankle Surg. 2001; 40: 374-389 Abstract Full Text PDF PubMed Scopus (50) Google Scholar , 8 Blitz N.M Christensen J.C Ford L.A Plantar plate ruptures of the second metatarsophalangeal joint. J Foot Ankle Surg. 2002; 41 (discussion, 139–141): 138-139 Abstract Full Text PDF PubMed Scopus (5) Google Scholar ). Powless and Elze ( 7 Powless S.H Elze M.E Metatarsophalangeal joint capsule tears an analysis by arthrography, a new classification system and surgical management. J Foot Ankle Surg. 2001; 40: 374-389 Abstract Full Text PDF PubMed Scopus (50) Google Scholar ) have included plantar plate tears in their classification system of lesser MTPJ capsular tears. The technique for isolated primary plantar plate repair of the lesser MTPJ is limited in the literature.