Flint Wesley W, Macias David M, Jastifer James R, Doty Jesse F, Hirose Christopher B, Coughlin Michael J
1 Orthopaedic Institute of Henderson, Henderson, NV, USA.
2 Columbus Orthopaedic Clinic, Columbus, MS, USA.
Foot Ankle Int. 2017 Mar;38(3):234-242. doi: 10.1177/1071100716679110. Epub 2016 Nov 16.
Lesser metatarsophalangeal (MTP) joint instability is a common cause of forefoot pain. Advances in operative technique and instrumentation have made it possible to anatomically treat plantar plate tears through a dorsal approach. Our goal was to evaluate the subjective, functional, and radiographic outcomes of plantar plate repair (PPR) from a dorsal approach.
A prospective case series was performed evaluating the results of PPR in 97 feet with 138 plantar plate tears. Patients underwent PPR from a dorsal approach with a Weil osteotomy. We followed patients at regular intervals for 12 months and collected data preoperatively and postoperatively with respect to visual analog scale (VAS) scores, MTP range of motion (ROM), paper pull-out test, American Orthopaedic Foot & Ankle Society (AOFAS) scores, satisfaction, and radiographic measures.
Eighty percent of patients scored "good" to "excellent" satisfaction scores at 12 months. The mean VAS pain score preoperatively was 5.4/10, and postoperatively was 1.5/10. The mean AOFAS scores increased from 49 to 81 points following surgery. The mean MTP ROM preoperatively was 43 degrees and postoperatively 31 degrees. Forty-two percent of toes passed the paper pull out test prior to surgery and 54% at 12 months. Mean metatarsal shortening was 2.4/3.1/1.2 mm for the second, third, and fourth metatarsals, respectively. The mean MTP joint angles preoperatively were 2/4.9/-1.3 degrees and postoperatively were 7.4/9.6/0.2 degrees, respectively, for the second, third, and fourth MTP joints.
We found that the plantar plate could be repaired through a dorsal approach with reliable outcomes. PPR was a viable option to anatomically restore the ligamentous support in the unstable lesser MTP joint.
Level IV, retrospective case series.
小趾跖趾关节（MTP）不稳定是前足疼痛的常见原因。手术技术和器械的进步使得通过背侧入路对跖板撕裂进行解剖学治疗成为可能。我们的目标是评估背侧入路跖板修复术（PPR）的主观、功能和影像学结果。
进行了一项前瞻性病例系列研究，评估97只足138处跖板撕裂的PPR结果。患者采用背侧入路联合Weil截骨术进行PPR。我们定期随访患者12个月，并收集术前和术后关于视觉模拟量表（VAS）评分、MTP活动范围（ROM）、纸张拔出试验、美国矫形足踝协会（AOFAS）评分、满意度和影像学测量的数据。
80%的患者在12个月时满意度评分达到“良好”至“优秀”。术前VAS疼痛评分平均为5.4/10，术后为1.5/10。术后AOFAS评分平均从49分提高到81分。术前MTP ROM平均为43度，术后为31度。术前42%的足趾通过纸张拔出试验，12个月时为54%。第二、第三和第四跖骨的平均缩短分别为2.4/3.1/1.2毫米。第二、第三和第四MTP关节术前平均MTP关节角度分别为2/4.9/-1.3度，术后分别为7.4/9.6/0.2度。
我们发现通过背侧入路修复跖板可获得可靠的结果。PPR是解剖学上恢复不稳定小MTP关节韧带支持的可行选择。
IV级，回顾性病例系列。
