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. 2022 Dec 23;10(12):23259671221137558.
doi: 10.1177/23259671221137558. eCollection 2022 Dec.

Arthroscopic Repair of Chronic Plantar Plate Tears of the First Metatarsophalangeal Joint: A New Surgical Technique With Patient Outcomes

Elisabeth Ellingsen Husebye  1 , Are Haukåen Stødle  1
Affiliations

Arthroscopic Repair of Chronic Plantar Plate Tears of the First Metatarsophalangeal Joint: A New Surgical Technique With Patient Outcomes

Elisabeth Ellingsen Husebye et al. Orthop J Sports Med. .

Abstract

Background: Most plantar plate tears of the first metatarsophalangeal joint can be treated successfully by nonoperative means. Primary repair may be indicated to restore continuity of the plantar structures and joint stability. Inadequate or failed nonoperative treatment may cause persistent pain and disability and thereby represent a career-threatening injury to an athlete. The chronic plantar plate tears are difficult both to diagnose and to treat. When surgical treatment is indicated, traditionally a wide plantar or 2 parallel incisions are used. An arthroscopic approach allows for verification and visualization of the injury and, at the same time, repair of the injury.

Purpose: To describe findings of plantar plate tears, present a new arthroscopic procedure for plantar plate tear repair, and present the outcomes after surgery.

Study design: Case series; Level of evidence, 4.

Methods: This was a retrospective study on the first 10 patients treated with the arthroscopic technique. The patients underwent surgery between June 2017 and January 2021. Patient data, clinical symptoms and findings, and operative details were obtained from the patient records. Patients were contacted via email to complete patient-reported outcome measures (Manchester Oxford Foot Questionnaire [MOxFQ] and Numeric Rating Scale [NRS] for pain).

Results: Four female and 6 male patients with a median age of 24 years (range, 12-44 years) were operated on at a median of 20 months (range, 2-38 months) after injury. Of the 10 patients, 8 had a hyperextension injury of the first metatarsophalangeal joint and 7 had a subtle valgus malalignment of the hallux; 8 patients were injured during sport activity. All patients reported plantar pain at pushoff. All but 1 patient returned to the same level of preinjury activity within 6 months. At a median of 29 months (range, 7-49 months) after surgery, the median MOxFQ score was 6 (range, 0-41) and the median NRS pain score was 0.

Conclusion: Arthroscopic plantar plate repair of chronic plantar plate tears resulted in a high rate of return to activity/sport and excellent outcome scores.

Keywords: arthroscopic repair; first metatarsophalangeal joint; hallux; metatarsophalangeal joint sprain; plantar plate; sport; turf toe.

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Conflict of interest statement

The authors declared that they have no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Placement of the portals related to the extensor halluces longus tendon (EHL) for arthroscopy of the right first metatarsophalangeal joint; the dorsolateral portal is A, and the dorsomedial portal is B. A branch of the peroneus superficialis nerve is marked on the dorsomedial aspect of the base of the great toe (arrow). The arthroscope enters the joint through the dorsomedial portal.
Figure 2.
Figure 2.
Location of the direct medial accessory portal (circle). EHL, extensor halluces longus tendon.
Figure 3.
Figure 3.
Placement of the self-retaining retractor with pin guides at the medial aspect of the right foot.
Figure 4.
Figure 4.
Dorsolateral view of the plantar plate tear (arrow) at the base of the proximal phalanx.
Figure 5.
Figure 5.
Illustrations of the suture passing through the plantar plate and the bone tunnels in the proximal phalanx. (A) The suture introducer enters the joint through the medial portal and passes through the plantar plate. (B) A loop wire passes through the suture introducer and is loaded with the suture. (C) The suture introducer is removed and leaves the suture in the plantar plate. (D) Bone tunnels are made in the proximal phalanx. (E) With a loop wire, the suture is led through the bone tunnels in the proximal phalanx. (F) The suture then passes through a bone tunnel in the proximal phalanx, through the plantar plate, and back through a second bone tunnel in the proximal phalanx.
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