Anatomic Reconstruction Versus Traditional Rebalancing in Lesser Metatarsophalangeal Joint Reconstruction
Section snippets
Patients and Methods
A case-control study was conducted of consecutive adult patients who had undergone surgical correction of lesser MTPJ imbalances. These patients were from the surgical medical records from January 2013 to December 2014. The institutional review board approved the present study (protocol no. 045-2014). The cases were defined as consecutive patients who had undergone anatomic plantar plate and collateral ligament reconstruction. The control group was defined as patients who had undergone
Results
The analysis demonstrated that the propensity matching was successful in balancing the cases (n = 18) and controls (n = 36). The groups were comparable (Table 1), with no statistically significant differences in age, gender, body mass index, laterality, MTPJ location, baseline deformity, baseline pain, preoperative ACFAS score, comorbidities, incidence of smoking, use of immunosuppressant agents, and concomitant procedures (Fig. 4). The data from 54 patients were analyzed, and multivariate
Discussion
The importance of the restoration of the plantar plate and collateral ligament integrity as a digital stabilizer is generally accepted but has not been well studied. The results of the present his study (Table 2) favor anatomic reconstruction of the lesser MTPJ over those using traditional techniques, such as MTPJ releases, capsulotomies, capsulorrhaphies, and tendon transfers. Of the cases undergoing the MTPJ reconstructive technique shown in Fig. 3, 94% achieved greater digital stability than
Acknowledgments
We would like to thank Drs. N. Jake Summers, Jill Ashcraft, Brandon Barrett, Michael Sganga, Michael Matthews, and Timothy Karthas for their valuable contributions related to portions of the data collection for this report.
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Cited by (9)
Plantar plate rupture: aetiology, diagnosis and treatment
2023, Orthopaedics and TraumaTreatment of Lesser Metatarsophalangeal Joint Instability With Plantar Plate Repair: A Systematic Review and Meta-Analysis
2022, Journal of Foot and Ankle SurgeryCitation Excerpt :This is because the overwhelming majority of subjects used in deriving summary estimates for change in VAS pain and change in AOFAS incorporated a concomitant Weil metatarsal osteotomy. In fact, there is actually very limited outcomes data in the published literature (n = 14 subjects) performing a dorsal approach repair without a concomitant lesser metatarsal osteotomy (7). It is important to recognize the limitations in our work.
Operative Management: Plantar Plate
2022, Clinics in Podiatric Medicine and SurgeryCitation Excerpt :Their soft tissue component included various combinations, which consisted of flexor tendon transfer, capsulotomy, capsulorrhaphy, tendon and skin lengthening procedures among several others. They concluded that anatomic PPR resulted in 94% digital stability compared with 60% in the soft tissue-rebalancing group.26 In a meta-analysis evaluating the flexor tendon transfer procedure, the authors found the procedure to have an overall patient satisfaction rate of 91.8% when including prospective articles of high quality.27
The Role of Lesser Metatarsophalangeal Joint Arthrodesis for Revision Surgery
2020, Clinics in Podiatric Medicine and SurgeryCitation Excerpt :When discussing lesser MTPJ arthrodesis, there are a limited number of published papers directly related to the topic for primary or revision hammertoe surgery. Currently, the most common surgical options for patients with primary hammertoe deformities with and without MTPJ pathologic condition and failed hammertoe procedures include soft tissue realignment, metatarsal osteotomy, resection arthroplasty, plantar plate repair, and amputation.1–8,10–19 In retrospect, there has been skepticism in the foot and ankle community about the utility or longevity of lesser MTPJ arthrodesis because many think it is not well tolerated, and some advocate that it should not be undertaken.
Lesser Metatarsophalangeal Joint Pathology Addressed With Arthrodesis: A Case Series
2019, Journal of Foot and Ankle SurgeryCitation Excerpt :Most recently, direct plantar plate repair with or without a metatarsal osteotomy has become an anatomically sound method for correcting the deformity (23,26,33–35). Cook et al (36) have recently published a case control study that retrospectively compares direct, anatomic repair of the plantar plate structure with more traditional capsule-tendon balancing procedures. The traditional balancing procedures included MTP joint capsulotomy, capsulorrhaphy, plantar plate release, extensor hood releases, arthrodesis of PIPJ, Z-tendon lengthening, skin lengthening procedures, flexor tendon transfers, pinning, and osteotomies of the metatarsal.
Comparison of Combination Weil Metatarsal Osteotomy and Direct Plantar Plate Repair Versus Weil Metatarsal Osteotomy Alone for Forefoot Metatarsalgia
2020, Journal of Foot and Ankle SurgeryCitation Excerpt :Although not specifically examined in this study, it is also possible that the better outcomes could have been mediated through enhanced stability of the MTP joint. Support for this can be found in the work of Cook et al (22), who observed significantly greater joint stability in their series of patients who underwent plantar plate repair (n = 18) compared with a control group not receiving plantar plate repair (n = 36). Similarly, in a prospective evaluation, Nery et al (4) also found enhanced stability in those patients who underwent direct repair of the injured plantar plate (grade 1 to 3 injuries) compared with those who did not (grades 0 and 4).
Financial Disclosure: This was an investigator-initiated study in which E.A. Cook and J.J. Cook applied for funding. This was not considered a grant, and we are both consultants for Smith & Nephew. The total amount provided in connection with our time for completing this study totaled $13,420; although we received this compensation, Smith & Nephew did not maintain rights to the data and did not have any input to the content or data analysis. We performed and interpreted our own data, and Smith & Nephew made no edits to the content of the report.
Conflict of Interest: J.J. Cook is a consultant to Smith & Nephew. E.A. Cook is a consultant to Smith & Nephew.