UNIFESP - Escola Paulista de Medicina, Orthopedics & Traumatology, São Paulo, Brazil.
Foot Ankle Int. 2012 Apr;33(4):301-11. doi: 10.3113/FAI.2012.0301.
Anatomical dissection of the second metatarsophalangeal (MTP) joint suggests that the plantar plate is the major stabilizing structure of the joint due to its central location and multiple important attachments. Many surgical procedures have been recommended when conservative treatment has failed, but some have had limited clinical success. The aim of our prospective study was to show the results obtained in the treatment of a group of patients with plantar plate tears by direct repair through a dorsal approach combined with a Weil metatarsal osteotomy with a minimum followup of 12 months.
We prospectively treated 28 patients (55 MTP joints) with lesser MTP joint instability, but only 22 patients (40 MTP joints) were treated by the direct repair of the plantar plate and were included in the study. All of them had initial complaints of acute forefoot pain with the subsequent development of deformity and instability of the MTP joints. All patients were evaluated clinically, radiographically, (plain radiographs and MRI exam), and by MTP joint arthroscopy. With this data, a direct correlation between the clinical staging and the anatomical grading for plantar plate dysfunction of each patient was determined
The plantar plate of the second MTP joint was the most commonly affected joint (63%), and Grade III type tear (transverse and/or longitudinal extension tear) was the most frequent type. With the surgical treatment, we were able to markedly improve the parameters studied (pain, medial or dorsomedial deviation of the toe, joint stability, muscle balance, and joint congruence) to acceptable levels, The AOFAS score improved substantially from an average of 52 points preoperatively to 92 points postoperatively.
The direct plantar plate repair combined with a Weil osteotomy and lateral soft tissue reefing can restore the normal alignment of the MTP joint. We have demonstrated that the anatomic repair of the plantar plate can correct the deviation of the affected toe (medial, dorsal, dorsomedial or dorsolateral), which lead to diminished pain with improved functional scores.
对第二跖趾关节（MTP）的解剖学研究表明，由于跖板位于关节中心位置且具有多个重要的附着点，因此它是关节的主要稳定结构。当保守治疗无效时，已经推荐了许多手术方法，但有些方法的临床效果有限。我们的前瞻性研究旨在展示通过背侧入路直接修复结合 Weil 跖骨截骨术治疗一组跖板撕裂患者的结果，随访时间至少为 12 个月。
我们前瞻性地治疗了 28 例（55 个 MTP 关节）有较小 MTP 关节不稳定的患者，但只有 22 例（40 个 MTP 关节）接受了跖板直接修复，并纳入了本研究。所有患者最初都有前足急性疼痛的主诉，随后出现 MTP 关节畸形和不稳定。所有患者均进行了临床、影像学（普通放射摄影和 MRI 检查）和 MTP 关节镜检查评估。根据这些数据，确定了每位患者跖板功能障碍的临床分期与解剖分级之间的直接相关性。
第二跖趾关节的跖板最常受累（63%），最常见的撕裂类型为 III 型撕裂（横断和/或纵向延伸撕裂）。通过手术治疗，我们能够显著改善研究参数（疼痛、脚趾的内侧或背内侧偏斜、关节稳定性、肌肉平衡和关节吻合度），使其达到可接受的水平。AOFAS 评分从术前的平均 52 分显著提高到术后的 92 分。
直接的跖板修复结合 Weil 截骨术和外侧软组织紧缩术可以恢复 MTP 关节的正常对线。我们已经证明，跖板的解剖修复可以纠正受累脚趾的偏斜（内侧、背侧、背内侧或背外侧），从而减轻疼痛，提高功能评分。
