Lesser MTP joints Arthroscopy: Anatomical Description and Comparative Dissection

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1 Lesser MTP joints Arthroscopy: Anatomical Description and Comparative Dissection Caio Nery, MD Michael Coughlin, MD Daniel Baumfeld, MD Fernando Raduan, MD Carla Chertman, MD

2 Disclosure Caio Nery, M.D. See Disclosure Information at the AAOS Disclosure Program. There is nothing to disclose related with the subject of this presentation. Daniel Baumfeld, M.D. See Disclosure Information at the AAOS Disclosure Program. There is nothing to disclose related with the subject of this presentation Fernado Raduan, M.D. See Disclosure Information at the AAOS Disclosure Program. There is nothing to disclose related with the subject of this presentation Carla Chertman, M.D. See Disclosure Information at the AAOS Disclosure Program. There is nothing to disclose related with the subject of this presentation Michael Coughlin, MD. Elsevier (royalties) / Arthrex, Inc (consultant, royalties). Fore more details, please refer to Disclosure Information at the AAOS Disclosure Program.

3 Introduction With improved technology, arthroscopic treatment of small joints of the foot has become a promising tool. The majority of papers in the literature are related to the 1 st MTP joint and report results on the treatment of osteochondral defects of the 1 st metatarsal head and sesamoiditis. To properly perform arthroscopic procedures in the small joints, a solid knowledge of the local anatomy is required. The aim of this article is to describe the normal arthroscopic anatomy of the lesser metatarsophalangeal (MTP) joints and to compare it to cadaveric dissection.

4 Methods We performed arthroscopic evaluation of 18 MTP joints of 6 normal adult frozen specimens (without local pathology). The second, third and fourth MTP joints were chosen, because of the incidence of pathologies on these joints. During the arthroscopic procedure, the anatomic structures were identified and marked with different color sutures. After that MTP joints were dissected and the anatomical structures were visualized and identified. We established 3 structures at the lateral portion of the MTP joint, 2 structures at the central portion and 3 structures at the medial portion of the joint (see next slide). With this data, a direct correlation between the arthroscopy of a normal MTP joint and the direct visualization of the joint was determined (P<0,001).

5 Methods All lesser MTP joints were studied arthroscopically followed by direct visualization under anatomic dissection. Medial Accessory Collateral Ligament (ACL) Proximal Phalanx Lateral Accessory Collateral Ligament (ACL) Proper Medial Collateral Ligament (PCL) Medial Bundle Central Recess Plantar Plate Lateral Bundle Proper Lateral Collateral Ligament (PCL) Metatarsal Head Synovial Tissue 2 nd Right MTP joint

6 Methods During the arthroscopy, the structures were identified and marked with sutures of different collors.

7 Results After the arthroscopic procedure, all the MTP joints were submitted to anatomical dissection to test the correlation between the arthroscopic and surgical findings.

8 Results

9 Results Table of each joint anatomical dissection X arthroscopy Topography Second MTP joint Third MTP joint Fourth MTP joint Central # Medial # 50% (3) 66,7 % ( 4) Lateral # 83,3 % (5) Table Final anatomical dissection x arthroscopy considering all joints together Topography Central Medial # # All MTP joints ( second, third, fourth) 18/ 18 15/ % Lateral # 17/18 97,2 %

10 Conclusion When comparing the arthroscopic evaluation of the lesser metatarsalphalangeal joint to direct visualization, we were able to locate and identify the intra-articular structures over 87% of the time. The lesser MTP joint arthroscopy is an effective tool to identify normal structures of the lesser MTP joint.

11 Bibliography 1. Coughlin MJ Subluxation and dislocation of the sec- ond metatarsophalangeal joint. Orthop Clin North Am 20: Debnath UK, Hemmady MV, Hariharan K. Indications for and technique of first MTP arthroscopy. Foot Ankle Int 2006;27(12): Carreira DS. Arthroscopy of the hallux. Foot Ankle Clin N Am 2009;14: Deland JT, Lee KT, Sobei M, DiCarlo EF (1995) Anatomy of the plantar plate and its attachments in the lesser metatarsal phalangeal joint. Foot Ankle Int 16: Deland JT, Sung II-Hoon The medial crossover toe: a cadaveric dissection. Foot Ankle Int 21(5): Ford LA, Collins KB, Christensen JC Stabilization of the subluxed second metatarsophalangeal joint: Xexor tendon transfer versus primary repair of the plantar plate. J Foot An- kle Surg 37(3): Green DR, Brekke M Anatomy, biomechanics and pathomechanics of lesser digital deformities. Clin Podiatr Med Surg 13: HirschBE,Minugh-PurvisN.Anatomyofthelowerextremity.Philadelphia:Elsevier, Johnston RB, Smith J, Daniels T (1994) The plantar plate of the lesser toes: an anatomical study in human cadavers. Foot Ankle Int 15(5): Lui TH. Arthroscopy and endoscopy of the foot and ankle: indications for new techniques. Arthroscopy 2007;23(8): Lui TH. Arthroscopic assisted repair of claw toe or overriding toe deformity: Plantar plate tenodesis. Arch Orthop Trauma Surg in press, available online 27 September, doi: /s Lui TH. First metatarsophalangeal joint arthroscopy in patients with hallux valgus. Arthroscopy 2008;24(10): Lui TH, Ng S, Chan KB. Endoscopic distal soft tissue proce- dure in hallux valgus surgery. Arthroscopy 2005;21:1403.e e7 14. Shurnas PS, Coughlin MJ. Arthritic conditions of the foot. In: Coughlin MJ, Mann RA, Saltzman CL, editors. Surgery of the foot and ankle, vol. 1. 8th edition. Philadelphia: Mosby Elsevier; p

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