SURGICAL REPAIR OF CHRONIC TEARS OF THE SECOND PLANTAR PLATE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YU Guangrong , YU Yaoping , ZHANG Peng , YANG Yunfeng , LI Bing , ZHANG Mingzhu.

Department of Orthopaedics, Tongji Hospital of Tongji University, Shanghai, 200065, P.R.China. Corresponding author: YU Guangrong, E-mail: yuguangrong@hotmail.com;

Corresponding author：

Keywords：

Chronic tear of the 2nd plantar plate; Metatarsophalangeal joint; Soft tissue repair

DOI：

10.7507/1002-1892.20130317

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Objective To explore the operative methods and the short-term effectiveness to repair chronic tears of the 2nd plantar plate. Methods Between June 2012 and June 2013, 14 patients with chronic tears of the 2nd plantar plate were treated. There were 4 males and 10 females with an average age of 65.9 years (range, 51-82 years) and with an average disease duration of 6.2 years (range, 5-9 years). The left side was involved in 5 cases and the right side in 9 cases. One patient had simple hammer toe; 2 patients had hallux valgus and claw toe; and 11 patients had hallux valgus and hammer toes. All of them had unstable the 2nd metatarsophalangeal joints. The results of modified Lachman test and drawer test were positive. The surgical treatment included a Weil osteotomy and plantar plate repair operation for rupture via dorsal incision after correcting hallux valgus. Results Primary healing of incision was obtained in all patients. Twelve patients were followed up 6-12 months (mean, 8.2 months). Hallux valgus, claw toe, and hammer toe were all corrected. The results of modified Lachman test and drawer test were negative at 3 months after operation. Mild pain of the 2nd metatarsophalangeal joint occurred, but no stiff was observed in 2 cases at 6 months after operation. The midfoot and forefoot score of American Orthopedic Foot and Ankle Society (AOFAS) was 90.50 ± 3.73 at last follow-up, which was significantly higher (t=21.724, P=0.000) than preoperative score (57.33 ± 4.99). Conclusion The plantar plate is the key to maintain the stability of the metatarsophalangeal joints, and surgical repair can achieve good short-term effectiveness in treating chronic tears of the 2nd plantar plate.

Citation： YU Guangrong,YU Yaoping,ZHANG Peng,YANG Yunfeng,LI Bing,ZHANG Mingzhu.. SURGICAL REPAIR OF CHRONIC TEARS OF THE SECOND PLANTAR PLATE. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(12): 1446-1449. doi: 10.7507/1002-1892.20130317 Copy

1.	Baravarian B, Thompson J, Nazarian D. Plantar plate tears: a review of the modified flexor tendon transfer repair for stabilization. Clin Podiatr Med Surg, 2011, 28(1): 57-68.
2.	Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
3.	Sanhudo JA, Ellera Gomes JL. Pull-out technique for plantar plate repair of the metatarsophalangeal joint. Foot Ankle Clin, 2012, 17(3): 417-424.
4.	Deland JT, Lee KT, Sobel M, et al. Anatomy of the plantar plate and its attachments in the lesser metatarsal phalangeal joint. Foot Ankle Int, 1995, 16(8): 480-486.
5.	Joseph R, Schroeder K, Greenberg M. A retrospective analysis of lesser metatarsophalangeal joint fusion as a treatment option for hammertoe pathology associated with metatarsophalangeal joint instability. J Foot Ankle Surg, 2012, 51(1): 57-62.
6.	Ford LA, Collins KB, Christensen JC. Stabilization of the subluxed second metatarsophalangeal joint: flexor tendon transfer versus primary repair of the plantar plate. J Foot Ankle Surg, 1998, 37(3): 217-222.
7.	Kernbach KJ. Hammertoe surgery: arthroplasty, arthrodesis or plantar plate repair. Clin Podiatr Med Surg, 2012, 29(3): 355-366.
8.	Coughlin MJ, Schutt SA, Hirose CB, et al. Metatarsophalangeal joint pathology in crossover second toe deformity: a cadaveric study. Foot Ankle Int, 2012, 33(2): 133-140.
9.	Sung W, Weil L Jr, Weil LS Sr, et al. Diagnosis of plantar plate injury by magnetic resonance imaging with reference to intraoperative findings. J Foot Ankle Surg, 2012, 51(5): 570-574.
10.	Klein EE, Weil L Jr, Weil LS Sr, et al. Magnetic resonance imaging versus musculoskeletal ultrasound for identification and localization of plantar plate tears. Foot Ankle Spec, 2012, 5(6): 359-365.
11.	Gregg JM, Silberstein M, Schneider T, et al. Sonography of plantar plates in cadavers: correlation with MRI and histology. AJR Am J Roentgenol, 2006, 186(4): 948-955.
12.	Sonnery-Cottet B, Archbold P, Thaunat M, et al. Fifth toe plantar plate repair in a professional soccer player: case report. Foot Ankle Int, 2012, 33(7): 598-601.
13.	Lui TH. Arthroscopic-assisted correction of claw toe or overriding toe deformity: plantar plate tenodesis. Arch Orthop Trauma Surg, 2007, 127(9): 823-826.
14.	Lui TH, Chan LK, Chan KB. Modified plantar plate tenodesis for correction of claw toe deformity. Foot Ankle Int, 2010, 31(7): 584-591.
15.	Queally JM, Zgraj OS, Walsh JC, et al. Use of the modified Stainsby procedure in correcting severe claw toe deformity in the rheumatoid foot: a retrospective review. Foot (Edinb), 2009, 19(2): 110-113.
16.	Gregg J, Silberstein M, Clark C, et al. Plantar plate repair and Weil osteotomy for metatarsophalangeal joint instability. Foot and Ankle Surgery, 2007, 13(3): 116-121.
17.	Weil L Jr, Sung W, Weil LS Sr, et al. Anatomic plantar plate repair using the Weil metatarsal osteotomy approach. Foot Ankle Spec, 2011, 4(3): 145-1450.
18.	Nery C, Coughlin MJ, Baumfeld D, et al. Lesser metatarsophalangeal joint instability: prospective evaluation and repair of plantar plate and capsular insufficiency. Foot Ankle Int, 2012, 33(4): 301-311.

1. Baravarian B, Thompson J, Nazarian D. Plantar plate tears: a review of the modified flexor tendon transfer repair for stabilization. Clin Podiatr Med Surg, 2011, 28(1): 57-68.
2. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7): 349-353.
3. Sanhudo JA, Ellera Gomes JL. Pull-out technique for plantar plate repair of the metatarsophalangeal joint. Foot Ankle Clin, 2012, 17(3): 417-424.
4. Deland JT, Lee KT, Sobel M, et al. Anatomy of the plantar plate and its attachments in the lesser metatarsal phalangeal joint. Foot Ankle Int, 1995, 16(8): 480-486.
5. Joseph R, Schroeder K, Greenberg M. A retrospective analysis of lesser metatarsophalangeal joint fusion as a treatment option for hammertoe pathology associated with metatarsophalangeal joint instability. J Foot Ankle Surg, 2012, 51(1): 57-62.
6. Ford LA, Collins KB, Christensen JC. Stabilization of the subluxed second metatarsophalangeal joint: flexor tendon transfer versus primary repair of the plantar plate. J Foot Ankle Surg, 1998, 37(3): 217-222.
7. Kernbach KJ. Hammertoe surgery: arthroplasty, arthrodesis or plantar plate repair. Clin Podiatr Med Surg, 2012, 29(3): 355-366.
8. Coughlin MJ, Schutt SA, Hirose CB, et al. Metatarsophalangeal joint pathology in crossover second toe deformity: a cadaveric study. Foot Ankle Int, 2012, 33(2): 133-140.
9. Sung W, Weil L Jr, Weil LS Sr, et al. Diagnosis of plantar plate injury by magnetic resonance imaging with reference to intraoperative findings. J Foot Ankle Surg, 2012, 51(5): 570-574.
10. Klein EE, Weil L Jr, Weil LS Sr, et al. Magnetic resonance imaging versus musculoskeletal ultrasound for identification and localization of plantar plate tears. Foot Ankle Spec, 2012, 5(6): 359-365.
11. Gregg JM, Silberstein M, Schneider T, et al. Sonography of plantar plates in cadavers: correlation with MRI and histology. AJR Am J Roentgenol, 2006, 186(4): 948-955.
12. Sonnery-Cottet B, Archbold P, Thaunat M, et al. Fifth toe plantar plate repair in a professional soccer player: case report. Foot Ankle Int, 2012, 33(7): 598-601.
13. Lui TH. Arthroscopic-assisted correction of claw toe or overriding toe deformity: plantar plate tenodesis. Arch Orthop Trauma Surg, 2007, 127(9): 823-826.
14. Lui TH, Chan LK, Chan KB. Modified plantar plate tenodesis for correction of claw toe deformity. Foot Ankle Int, 2010, 31(7): 584-591.
15. Queally JM, Zgraj OS, Walsh JC, et al. Use of the modified Stainsby procedure in correcting severe claw toe deformity in the rheumatoid foot: a retrospective review. Foot (Edinb), 2009, 19(2): 110-113.
16. Gregg J, Silberstein M, Clark C, et al. Plantar plate repair and Weil osteotomy for metatarsophalangeal joint instability. Foot and Ankle Surgery, 2007, 13(3): 116-121.
17. Weil L Jr, Sung W, Weil LS Sr, et al. Anatomic plantar plate repair using the Weil metatarsal osteotomy approach. Foot Ankle Spec, 2011, 4(3): 145-1450.
18. Nery C, Coughlin MJ, Baumfeld D, et al. Lesser metatarsophalangeal joint instability: prospective evaluation and repair of plantar plate and capsular insufficiency. Foot Ankle Int, 2012, 33(4): 301-311.

Chinese Journal of Reparative and Reconstructive Surgery

SURGICAL REPAIR OF CHRONIC TEARS OF THE SECOND PLANTAR PLATE

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