LESSER MTPJ INSTABILITY- SURGICAL OPTIONS REFERENCES

Size: px

Start display at page:

Download "LESSER MTPJ INSTABILITY- SURGICAL OPTIONS REFERENCES"

Mae Lynch
5 years ago
Views:

1 LESSER MTPJ INSTABILITY- SURGICAL OPTIONS REFERENCES Prepared by: Richard T. Bouché, DPM Seattle, WA FDL TENDON TRANSFER -Iglesias MEL, Vallejo RB, Jules KT, et al.: Meta-analysis of flexor tendon transfer for the correction of lesser toe deformities. J Am Pod Med Assoc 102(5): , 2012 FDL TENDON TRANSFER +/- HT REPAIR +/- OSTEOTOMY OR STAINSBY PROCEDURE -Peck CN, Macleod A, Barrie J: Lesser MTPJ instability presentation, management and outcomes. Foot & Ankle Int 33(7): , 2012 PLANTAR PLATE REPAIR (Plantar) -Ford LA, Collins KB, Christensen JC: Stabilization of the subluxed 2 nd MTPJ: flexor tendon transfer vs. primary repair of the plantar plate. J Foot Ankle Surg 37: , Powless SH, Elze ME: Metatarsophalangeal joint capsule tears: an analysis by arthrography, a new classification system & surgical management. J Foot Ankle Surg 40: , McAlister JE, Hyer CF: The direct plantar plate repair technique. Foot Ankle Spec 6(6): , 2013 PLANTAR PLATE REPAIR (Plantar) + HT REPAIR + FDL TENDON TRANSFER +/- OSTEOTOMY -Bouché RT, Heit EJ: Combined plantar plate and hammertoe repair with flexor digitorum longus tendon transfer for chronic, severe, sagittal plane instability of the lesser MTPJs: preliminary observatons. J Foot Ankle Surg 47(2): , 2008

2 PLANTAR PLATE REPAIR (Dorsal) + OSTEOTOMY -Gregg J, Silberstein M, Clark C, et al.: Plantar plate repair and Weil osteotomy for MTPJ instability. Foot Ankle Surg 13: , Weil L Jr., Sung W, Weil L Sr, et al.: Corrections of 2 nd MTPJ instability using a Weil osteotomy & dorsal approach plantar plate repair: a new technique. Foot & Ankle Surg 10:33-39, Nery C, Coughlin MJ, Baumfield D, et al.: Lesser MTPJ instability: prospective evaluation & repair of plantar plate & capsular insufficiency. Foot Ankle Int 33(4): , Chalayon O, Chertman C, Guss AD, et al.: Role of plantar plate and surgical reconstruction techniques on static stability of lesser metatarophalangeal joints: a biomechanical study. Foot Ankle Int 34(10): , Nery C, Coughlin MJ, Baumfield D, et al.: Prospective evaluation fo protocol for surgical treatment of lesser MTPJ plantar plate tears. Foot Ankle Int 35(9): , Watson TS, Reid DY, Frerichs TL: Dorsal approach for plantar plate repair with Weil osteotomy: operative technique. Foot Ankle Spec 35(7): , Nery C, Raduan F, Catena F, et al.: Plantar plate radiofrequency and Weil osteotomy for subtle metarsophalangeal joint instability. J Orthop Surg Res 10:180, 2015 PLANTAR PLATE REPAIR (Dorsal) WITHOUT OSTEOTOMY -Jastifer JR, Coughlin MJ: Exposure via sequential release of the metatarsophalangeal joint for plant plate repair through a dorsal approach without an intraarticular ostetotomy. Foot Ankle Int 36(3): , 2015 FDL TENDON TRANSFER + OSTEOTOMY -Note: Refer to Nery, Coughlin, Baumfield et al. articles above for description of these 2 procedures for end-stage dislocated toes at MTPJ level. The authors recommend these procedures because of extensive plantar plate damage

3 LESSER MTPJ FUSION +/- 1 ST MTPJ FUSION -Karlock LG: Second MTPJ fusion: a new technique for crossover hammertoe deformity- a preliminary report. J Foot Ankle Surg 42(4): , Joseph r, Schroeder K, Greenberg M: A retrospective analysis of lesser MTPJ fusion as a treatment option for hammertoe pathology associated with MTPJ instability. J Foot Ankle Surg 51:57-62, 2012 STAINSBY PROCEDURE -Stainsby GD: Patholgical anatomy and dynamic effects of displaced plantar plate & importance of integrity of plantar platedeep transverse metatarsal ligament tie-bar. Ann R Coll Surg Engl 79:56-68, Qeually JM, Zgraj OS, Walsh JC, et al.: Use of modified Stainsby procedure in correcting severe claw toe deformity in rheumatoid foot: a retrospective review. The Foot 19: , Dodd L, Atinga M, Foote J, et al.: Outcomes after Stainsby procedure in lesser toes: an alternative procedure for correction of rigid claw toe deformity. J Foot Ankle Surg 50: , 2011 AMPUTATION -Gallentine JW, DeOrio JK: Removal of 2 nd toe for severe hammertoe deformity in elderly patients. Foot Ankle Int 26: , 2005

4 RECOMMENDED SURGICAL PROCEDURES FOR LESSER MTPJ INSTABILITY (BASED ON BOUCHĒ/HEIT CLASSIFICATION) Stage 0 (No instability but extensus deformity that does not reduce w/ dorsal capsulotomy & EDL tendon lengthening): FDL Transfer +/- HT Repair Stage 1A (<50% Subluxation): PPR +/- HT Repair +/- Osteotomy Stage 1B (>50% Subluxation): PPR + HT Repair +/- FDL Transfer +/- Osteotomy Stage 2 (Dislocatable): PPR + HT Repair +/- FDL Transfer +/- Osteotomy Stage 3 (Dislocated): JOINT PRESERVATION (PPR + HT Repair + FDL Transfer +/- Osteotomy) vs. JOINT ELIMINATION (Arthroplasty, Arthrodesis, Amputation) Updated Jan 2016

5 Clinical staging of Lesser Metatarsophalangeal Joint Instability is based on which of following: a. Lopresti test b. Jendrassik maneuver c. horizontal drawer test d. Lachman maneuver* e. none of the above The presence of which of following clinical findings related to LMTPJI would mean a less favorable prognosis for a successful surgical outcome: a. multiple planes of toe deformity b. arthritic MTPJ c. previous failed surgery to fix LMTJI d. fixed or irreducible deformity e. all of the above* Which of the following procedures would be the most critical procedure to perform in an athlete with a subacute dislocatable sagittal plane instability of the 2 nd toe? a. shortening 2 nd metarsal osteotomy b. EDL tendon lengthening c. hammertoe correction d. FDL tendon transfer e. plantar plate repair*

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

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 Disclosure