title: Exposure via sequential release of the metatarsophalangeal joint for plantar plate repair through a dorsal approach without an intraarticular osteotomy.
abstract: BACKGROUND
  Traditionally, plantar plate repairs have been performed from either a direct plantar approach or through a dorsal approach utilizing an intraarticular metatarsal osteotomy. It is unknown if a plantar plate repair can be reliably performed through a dorsal approach without an osteotomy.
  
  
  METHODS
  The second through fourth metatarsal phalangeal (MTP) joints of 4 fresh frozen cadavers were sequentially dissected and the exposure of the plantar plate was quantified with a digital micrometer. A suture passer was then utilized to pass a suture through the released plantar plate without a metatarsal osteotomy.
  
  
  RESULTS
  The mean plantar plate exposure after capsulotomy was 1.1 mm, after capsulotomy and release of the collateral ligaments exposure was 2.5 mm, after the addition of a release of plantar structures with a McGlamry elevator exposure was 4.1 mm, and after the addition of a plantar plate takedown the exposure was 5.3 mm. Every specimen had a minimum of 4 mm of exposure. Two sutures were successfully passed through every plantar plate with the exposure obtained.
  
  
  CONCLUSIONS
  Significant improvement in exposure of the plantar plate was achieved with each successive structure released .
  
  
  CONCLUSIONS
  Successful plantar plate repair can be reliably performed through a dorsal approach without a metatarsal osteotomy in a cadaveric model.
authors.affiliation: Borgess Orthopedics, Kalamazoo, MI, USA jrjast@gmail.com.
authors.forename: James R
authors.initials: JR
authors.lastname: Jastifer
authors.affiliation: Saint Alphonsus Coughlin Foot & Ankle Clinic, Boise, ID, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Coughlin
mesh_terms: D006801:Humans; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D000069262:Plantar Plate / Q000293:injuries* / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation*
keywords: MTP instability; crossover second toe; metatarsophalangeal joint; plantar plate repair