Radiographic Evaluation of Plantar Plate Injury: An In Vitro Biomechanical Study

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1 AOFAS Meeting 2012 San Diego, CA Radiographic Evaluation of Plantar Plate Injury: An In Vitro Biomechanical Study Norman E. Waldrop, III, MD Chris Zirker, MS Coen A. Wijdicks, PhD Robert A. Laprade, MD, PhD Thomas O. Clanton, MD The Steadman Clinic June 2012

2 Radiographic Evaluation of Plantar Plate Injury: An In Vitro Biomechanical Study Norman E. Waldrop, III, MD My disclosure is in the Final AOFAS Program Book. I have no potential conflicts with this presentation.

of the sesamoid bones and turf toe injuries No effort has been made to quantify

3 Turf Toe: Introduction Debilitating condition with a broad spectrum of symptoms Prior studies have demonstrated a qualitative relationship between the movement of the sesamoid bones and turf toe injuries No effort has been made to quantify the changes in movement of the sesamoids with respect to the extent of injury

4 Hypothesis A quantitative evaluation of turf toe injury is possible via radiographic analysis by measuring the relationship between capsuloligamentous injury and sesamoid movement.

5 Methods 24 Fresh Frozen Specimens The four structures of the plantar plate capsuloligamentous complex were cut in four different orders Lateral flouroscopic images taken with each cut

6 Methods Standardized dorsiflexion stress with 15 N at 45 to floor Surgeon performed manual dorsiflexion stress test Statistical testing performed was a repeated measures ANOVA with Tukey post hoc

Results No differences between the four groups for each cut N: 24 Specimens Cut 1 Cut 2 Cut 3 Cut 4 Surgeon 0.08 1.20 3.04* 6.96* Standard 0.68 1.53 3.37* 7.

7 Results No differences between the four groups for each cut N: 24 Specimens Cut 1 Cut 2 Cut 3 Cut 4 Surgeon * 6.96* Standard * 7.89* Measurements in millimeters (mm) Δ from intact state The third ligament cut was statistically significant compared to the intact state * Statistically significant p 0.05 Intraobserver intraclass correlation between Surgeon and Standardized groups for each observer was 0.95 Interobserver intraclass correlation for radiographic measurements of the phalangeal sesamoid distances for surgeon group and the standardized group was 0.94 and 0.88, respectively.

8 Discussion A 3mm difference in movement of the sesamoids compared to the intact state after turf toe injury is highly predictive of a three ligament injury Study identifies more severe injuries that could lead to instability of the joint

9 Conclusion First study to quantify change in excursion based on the extent of ligamentous injury Study aids in identifying those patients who need more advanced imaging, i.e. MRI Aids in diagnosing more severe turf toe injuries Guide the clinician in treatment decisions

10 References Bowers KD Jr, Martin RB. Turf-Toe: a shoe-surface related football injury. Med Sci Sports. 1976;8(2): Clanton TO, Butler JE, Eggert A. Injuries to the metatarsophalangeal joints in athletes. Foot Ankle. 1986;7(3): Clanton TO, Ford JJ. Turf Toe Injury. Clin Sports Med. 1994;13(4): McCormick JJ, Anderson RB. Rehabilitation following turf toe injury and plantar plate repair. ClinSports Med. 2010; 29(2): McCormick JJ, Anderson RB. The great toe: failed turf toe, chronic turf toe, and complication of sesamoid injuries. Foot Ankle Clin. 2009;14(2): Prieskorn D, Graves SC, Smith RA. Morphometric analysis of the plantar plate apparatus of the first metatarsophalangeal joint. Foot Ankle. 1993;14(4): Rodeo SA, O'Brien S, Warren RF, Barnes R, Wickiewicz TL, Dillingham MF. Turftoe: an analysis of metatarsophalangeal joint sprains in professional football players. Am J Sports Med. 1990;18(3):280-5.

TURF TOE IN A TAEKWANDOO PLAYER: CASE REPORT

Journal of Sports Science and Medicine (2004) 3, 96-100 http://www.jssm.org Case report TURF TOE IN A TAEKWANDOO PLAYER: CASE REPORT Namık Sahin 1, Teoman Atici 1, Sadik M. Bilgen 2 and Omer F. Bilgen