The plantar plate is a major structure that maintains metatarsophalangeal joint (MTPJ) stability and has only recently gained attention. Anatomic plantar plate repair can directly address the pathologic entity, rather than relying on indirect reduction of the MTPJ instability by osteotomy or tendon transfer techniques. The present report aimed to determine the effectiveness of plantar plate repair for the treatment of patients with lesser MTPJ instability. Different databases were searched using the guidelines in the Cochrane Handbook and recommendations from the Preferred Reporting Items for Systematic reviews and Meta-Analysis statement. Six case series, describing 162 patients who had undergone plantar plate repair in conjunction with either Weil osteotomy or flexor digitorum longus transfer, were retrieved. Favorable outcomes were described in each of the studies included in the present systematic review. However, these results should be interpreted with caution because of the methodologic limitations and biases inherent in the included studies. More rigorous clinical investigations are required to fully understand the effectiveness of plantar plate repair for the management of lesser MTPJ instability.
Level of Clinical Evidence
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- Evaluation and treatment of lesser metatarsophalangeal joint instability: the repair of plantar plate insufficiency through a dorsal approach.Oper Tech Sports Med. 2014; 22: 339-347
- Etiology and management of lesser toe metatarsophalangeal joint instability.Foot Ankle Clin. 2014; 19: 385-405
- Crossover second toe deformity.Foot Ankle. 1987; 8: 29-39
- When to suspect crossover second toe deformity.J Musculoskelet Med. 1987; 39: 48
- Traumatic dislocations of the lesser toes.Foot Ankle Int. 1997; 18: 406-411
- Subluxation and dislocation of the second metatarsophalangeal joint.Orthop Clin North Am. 1989; 20: 535-551
- Results of flexor-to-extensor and extensor brevis tendon transfer for correction of the crossover second toe deformity.Foot Ankle Int. 1999; 20: 781-788
- The role of toe flexor-to-extensor transfer in correcting metatarsophalangeal joint instability of the second toe.Foot Ankle Int. 2005; 26: 675-679
- Stabilization of the subluxed second metatarsophalangeal joint: flexor tendon transfer versus primary repair of the plantar plate.J Foot Ankle Surg. 1998; 37: 217-222
- Prospective evaluation of protocol for surgical treatment of lesser MTP joint plantar plate tears.Foot Ankle Int. 2014; 35: 876-885
- Dorsal approach for plantar plate repair with Weil osteotomy: operative technique.Foot Ankle Int. 2014; 35: 730-739
- Plantar plate repair and Weil osteotomy for metatarsophalangeal joint instability.Foot Ankle Surg. 2007; 13: 116-121
- Combined plantar plate and hammertoe repair with flexor digitorum longus tendon transfer for chronic, severe sagittal plane instability of the lesser metatarsophalangeal joints: preliminary observations.J Foot Ankle Surg. 2008; 47: 125-137
- Anatomic plantar plate repair using the Weil metatarsal osteotomy approach.Foot Ankle Spec. 2011; 4: 145-150
- Crossover second toe: demographics, etiology, and radiographic assessment.Foot Ankle Int. 2007; 28: 1223-1237
- Lesser metatarsophalangeal joint instability: prospective evaluation and repair of plantar plate and capsular insufficiency.Foot Ankle Int. 2012; 33: 301-311
- Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013; 27: 1446-1449
- You are how you recruit: a cohort and randomized controlled trial of recruitment strategies.BMC Med Res Methodol. 2014; 14: 111
- Recruitment strategies for an acupuncture randomized clinical trial of reproductive age women.Complement Ther Med. 2009; 17: 229-235
- Influence of various recruitment strategies on the study population and outcome of a randomized controlled trial involving patients with osteoarthritis of the hip or knee.Arthritis Rheum. 2005; 53: 375-382
- Patient outcomes from 10 years of annual diabetes reviews in New Zealand.Diabetes Res Clin Pract. 2013; 102: 129-137
- The increasing disease duration of patients at the time of orthopaedic surgery for rheumatoid arthritis.Rheumatol Int. 2012; 32: 3323-3324
- Diagnosis of plantar plate injury by magnetic resonance imaging with reference to intraoperative findings.J Foot Ankle Surg. 2012; 51: 570-574
- Microarterial anatomy of the lesser toe proximal interphalangeal joints.J Hand Surg Am. 1998; 23: 256-260
- The plantar plate of the lesser toes: an anatomical study in human cadavers.Foot Ankle Int. 1994; 15: 276-282
- Turf toe: anatomy, diagnosis, and treatment.Sports Health. 2010; 2: 487-494
- Sequential dissection for exposure of the second metatarsophalangeal joint.Foot Ankle Int. 2011; 32: 294-299
Klieman CH. U.S. Patent No. 5,171,253, U.S. Patent and Trademark Office, Washington, DC, 1992.
- Joint stiffness of the ankle during walking after successful mobile-bearing total ankle replacement.Gait Posture. 2008; 27: 115-119
- Procedures for performing systematic reviews.J Theoretical Appl Inform Technol. 2013; 55: 2049-2075
Published online: September 08, 2017
Financial Disclosure: None reported.
Conflict of Interest: None reported.
© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.