title: Plantar Plate Repair for Lesser Metatarsophalangeal Joint Instability.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: 1 Orthopaedic Institute of Henderson, Henderson, NV, USA.
authors.forename: Wesley W
authors.initials: WW
authors.lastname: Flint
authors.affiliation: 2 Columbus Orthopaedic Clinic, Columbus, MS, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Macias
authors.affiliation: 3 Borgess Orthopedics, Kalamazoo, MI, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Jastifer
authors.affiliation: 4 University of Tennessee Erlanger Foot and Ankle Institute, Chattanooga, TN, USA.
authors.forename: Jesse F
authors.initials: JF
authors.lastname: Doty
authors.affiliation: 5 Coughlin Foot and Ankle Clinic, Saint Alphonsus Regional Medical Center, Boise, ID, USA.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Hirose
authors.affiliation: 5 Coughlin Foot and Ankle Clinic, Saint Alphonsus Regional Medical Center, Boise, ID, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Coughlin
mesh_terms: D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D000069262:Plantar Plate; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D014034:Toes / Q000601:surgery*
keywords: crossover toe; metatarsophalangeal joint instability; plantar plate; plantar plate repair