Rationale for surgical treatment of lesser MTP joint plantar plate tears

a study of 100-MTP joints prospectively treated

Abstract

Obejctive: The purpose of this study was to prospectively evaluate the surgical outcomes for the different grades of plantar plate tears and propose a treatment rationale. Methods: Sixty-eight patients (100 MTP joints) were prospectively enrolled and graded according to Anatomical Grade System for plantar plate tears. Based on this classification the appropriate surgical procedure was choose as follows: Grades 0 and I, thermal shrinkage with radio frequency; Grades II and III, direct reinsertion of the plantar plate; Grade IV, flexor-to-extensor tendon transfer. All surgical procedures were associated with a Weil metatarsal osteotomy. Evaluations were performed before and after surgical treatment with a mean follow-up of 2 years (12 ~ 36 months), using clinical and radiological parameters: AOFAS Lesser MTP-IF Scale; Visual Analogic Pain Scale (VAS); ground touch; joint stability and toe purchase. Results: The analysis of the clinical parameters demonstrated a significant improvement of all groups (p<0.0001) after surgical treatment, but Grade IV group presented lower VAS variation and fair AOFAS score (72 points). All groups improved regarding physical exam parameters, but Grade I, III and IV tears presented proportionally less stable MTP joints following surgery, lower proportion of normal postoperative toe purchase and ground touch. All groups showed a significant improvement regarding the studied radiographic parameters. Conclusion: All operatively treated patients had significant improvement with regards to subjective and objective parameters. Grades I, III and IV presented inferior results when compared to Grades 0 and II. Level of Evidence: IV, case series.