A versatile method for dorsal-approach plantar plate repair using standard operative instruments

Shun-Min Chang, Peng-Ju Huang, Chui Jia Farn, Shin-Yiing Lin, Chen-Chie Wang, Chung-Li Wang, Pei-Yu Chen, Shun-Min Chang, Peng-Ju Huang, Chui Jia Farn, Shin-Yiing Lin, Chen-Chie Wang, Chung-Li Wang, Pei-Yu Chen

Abstract

Background: The plantar plate is an important static stabilizer of the lesser metatarsophalangeal joints, and disruptions of the plantar plate can lead to significant instability and lesser toe deformities. In recent years, direct plantar plate repair has been proposed. Although direct repair via a dorsal approach is attractive, a torn plantar plate is small and difficult to access using regular instruments in a restricted operative field.

Methods: In this report, a unique method for plantar plate repairs was used to repair various configurations of plantar plate tears with standard operative instruments that are available in most operating rooms.

Results: Using this method, 10 patients underwent plantar plate repairs, and the mean follow-up period was 24 (range, 14-38) months. The mean visual analog scale score for pain preoperatively was 4.1 (range, 0-6) and decreased to 0.6 (range, 0-3) at last follow-up. Postoperatively, the mean visual analog scale score for satisfaction was 9.6 (range, 8-10) and the mean American Orthopedic Foot and Ankle Society forefoot score was 88.8 (range, 75-100).

Conclusions: Our study proposes an inexpensive and versatile method for plantar plate repair via a dorsal approach that uses standard operative instruments.

Trial registration: ClinicalTrials.gov , NCT04949685 . July 2, 2021 - Retrospectively registered, LEVEL OF CLINICAL EVIDENCE: 4.

Keywords: Dorsal approach; Hammer toe deformity; Lesser metatarsophalangeal joint instability; Metatarsalgia; Plantar plate tear.

Conflict of interest statement

The authors of this work have nothing to disclose.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
The equipment needed for this method included four straight needles, three 3–0 silk sutures, one 2–0 Ticron suture, and one 1.0-mm Kirschner-wire
Fig. 2
Fig. 2
a Two sets of sutures were used in anatomical Grade II transverse tears or Grade III, “7”-type tears. b An anatomical Grade III, “T”-type tear could be converted into a transverse tear. c Using a straight needle makes it easier to target any point in the operator’s sightline, even in a considerably restricted field
Fig. 3
Fig. 3
a our straight needles were sequentially put through the plantar plate, and all of them should be located within the wire loop. b Each needle was driven through the plantar skin after threading. c The suture was detached from the needle after passing through the plantar skin
Fig. 4
Fig. 4
a-b Sutures and suture loops were passed to the plantar side. c As the suture retrieving loop was withdrawn, the distal end of the suture and suture loops were retrieved from the plantar skin; both ends came out from the dorsal aspect
Fig. 5
Fig. 5
a-c The free end of the suture was passed through the plantar plate (from the dorsal to the plantar or from the plantar to the dorsal) with the aid of suture loops
Fig. 6
Fig. 6
a Typically, two sets of sutures were used in anatomical Grade II transverse tears or Grade III, “7”-type tears. b-d Both ends of the sutures were then passed from the plantar to the dorsal through two tunnels, and the metatarsophalangeal joint could be reduced by tightening the sutures
Fig. 7
Fig. 7
a-b The operative indications for plantar plate repair were symptomatic lesser metatarsophalangeal joint instability and most of the patients received concomitant operations for hallux valgus. c The suture retrieving loop was placed between the plantar plate and the flexor digitorum longus tendon. d Several clefts in the cortical bone of the distal insertion of the plantar plate were made to facilitate re-attachment of the plantar plate, and two tunnels were created to receive the sutures. e-f The hammer toe deformity was corrected after operation

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