title: MRI evaluation of the MTP plantar plates compared with arthroscopic findings: a prospective study.
abstract: BACKGROUND
  Instability of the lesser metatarsophalangeal (MTP) joints has been widely reported and plantar plate insufficiency is a key part of this pathologic process. The diagnosis is made clinically but can be aided by imaging studies, particularly magnetic resonance imaging (MRI); however, the sensitivity and accuracy of this method compared to direct visualization of these lesions has not yet been established, nor has interobserver accuracy of MRI been assessed for evaluation of plantar plate pathology. In this study, our goals were to identify the accuracy of the MRI in describing plantar plate tears when compared to direct arthroscopic visualization using an anatomic grading system and to test the influence of an anatomic grading system in the accuracy of the MRI readings.
  
  
  METHODS
  We evaluated the clinical exam, MRI scans, and arthroscopic findings of 35 patients with lesser MTP instability.
  
  
  RESULTS
  Using an anatomic grading system, a distinct improvement in the radiological evaluation and interpretation occurred. Knowledge of the pattern of plantar plate tears by a radiologist enabled them to locate and describe the type of tears of the plantar plate on the MRI. The amount of training and the experience of the radiologist were also important factors in our study. The senior radiologists had much better levels of accuracy (Group A, 77.0%; Group B, 88.5%) than less experienced radiologists.
  
  
  CONCLUSIONS
  Prior knowledge of the pathophysiology and morphological types of lesions of the plantar plates was helpful for accurate identification and description of the tears by the radiologist.
  
  
  METHODS
  Level II, prospective comparative study.
authors.affiliation: UNIFESP-Escola Paulista de Medicina, São Paulo, Brazil.
authors.forename: Caio
authors.initials: C
authors.lastname: Nery
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Coughlin
authors.forename: Daniel
authors.initials: D
authors.lastname: Baumfeld
authors.forename: Tania Szejnfeld
authors.initials: TS
authors.lastname: Mann
authors.forename: André Fukunishi
authors.initials: AF
authors.lastname: Yamada
authors.forename: Eloy Avila
authors.initials: EA
authors.lastname: Fernandes
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008683:Metatarsophalangeal Joint / Q000473:pathology*; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity