Weil osteotomy and flexor to extensor transfer for irreparable plantar plate tear: prospective study

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1 Weil osteotomy and flexor to extensor transfer for irreparable plantar plate tear: prospective study Daniel Baumfeld, MD Fernando Raduan, MD Fernanda Catena, MD Tania Mann, MD Caio Nery, MD

2 Disclosure My disclosure is in the Final AOFAS Mobile App I have no potential conflicts with this presentation

Introduction The anatomy of the plantar plate has received increasing attention in the literature as techniques for repair or reconstruction of this important anatomic structure As the

3 Introduction The anatomy of the plantar plate has received increasing attention in the literature as techniques for repair or reconstruction of this important anatomic structure As the metatarsophalangeal ( MTP) joint instability progress, the surrounded soft tissue become disrupted, with no possibility of direct repair Some authors have proposed a classification system that not only stages the plantar plate lesion clinically but also describes different anatomical types of plantar plate tears The objective of this study is to present the result of the operative treatment of a specific group of patients with irreparable plantar plate tears.

examination, radiologic assessment and a diagnostic MTP joint arthroscopy Post

4 Methods We prospectively enrolled eleven patients (17 MTP joints) with lesser MTP joint instability All of them were submitted to a medical interview, physical examination, radiologic assessment and a diagnostic MTP joint arthroscopy Post operative analyses: joint stability, toe elevation, toe purchase, AOFAS and VAS score.

5 Methods Patients included in our study were those with gross instability and deformity The joint instability was measured using the Thompson-Hamilton MTP "drawer" test and rated as:

6 Methods After Start arthroscopy, with arthroscopy the Plantar evaluation Plate was to diagnosed confirm the as plantar being irreparable plate irreparability and graded as 4 of the anatomic classification

7 Technique

8 Average follow up: 20 month Results Stability p = 0, % of the joints improved

9 Results AOFAS Grade 4 ( n= 17) Preoperative n (%) Mean 25,9 # Min Max 9 52 Postoperative n (%) Mean 72,2 # Min Max VAS Grade 4 ( n= 17) Preoperative n (%) Mean 7,7* Min Max 7 8 Postoperative n (%) Mean 2,29* Min Max 0 4 # p-valor (pré x pós) - < 0,0001 *p-valor (pré x pós) - < 0,0001

10 Toe purchase Grade 4 ( n= 17) Results Preoperative n (%) Postoperative n (%) Present 2 (11,8%) Diminish 0 (0%) Absent 15 (88,2%) Present 3 (17,6%) Diminish 4 (23,5%) Absent 10 (58,8%) p = 0,1653 p value pre x post = 0,0047 Preoperative n (%) Postoperative n (%) Elevation Grade 4 ( n= 17) No 0 (0%) Yes 17 (100%) No 8 (47,1%) Yes 9 (52,9%)

transfer promote pain relief and improve alignment and

11 Conclusion Although it may be associated with some residual deformity, the Weil osteotomy with flexor to extensor tendon transfer promote pain relief and improve alignment and stability to joints with extensive and irreparable plantar plate tears

12 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

Lesser MTP joints Arthroscopy: Anatomical Description and Comparative Dissection

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