Reconstruction of the plantar plate of the metatarsophalangeal joint using adorsal transarticular approach

Abstract

Reconstruction of the plantar plate to stabilize adislocated or instable lesser metatarsophalangeal joint using adorsal approach in combination with aWeil osteotomy. Dislocated or instable lesser metatarsophalangeal joint with rupture of the plantar plate. Infection, circulatory disorders, symptomatic degenerative arthritis lesser metatarsophalangeal joint. Weil osteotomy using adorsal approach. Temporary dislocation of the metatarsal head as proximal as possible. Inspection of the plantar plate. Assessment and classification of type and extent of the rupture. Suturing of the plantar plate to the plantar bases of the proximal phalanx. Fixation of the Weil osteotomy with correction of the metatarsal alignment. Weight bearing in apostoperative shoe as tolerated. X‑ray control 6weeks postoperative. Full weight bearing in aconventional shoe after bony consolidation. A total of 23surgical reconstructions of the plantar plate (complete plantar plate repair) between 12/2012 and 10/2014 were performed. The mean follow-up was 18.6 (12-30) months. Five secondary dislocations were observed: onedeep postoperative infection, one early dislocation of unknown cause, one secondary dislocation caused by severe hallux valgus recurrence, onemassive foreign body reaction to the non-resorbable sutures, and one late secondary dislocation occurred between 6weeks and 1year postoperative. Normal function of the reconstructed joint was achieved in 13 of the 23reconstructions (57%). Areduced toe purchase was observed in 3reconstructions (13%). Afloating-toe resulted after 7reconstructions (30%).