SLR - February 2023 - Michelle DeJesus, DPM
Title: Arthroscopic Repair of Chronic Plantar Plate Tears of the First Metatarsophalangeal JointReference: Husebye EE, Stødle AH. Arthroscopic Repair of Chronic Plantar Plate Tears of the First Metatarsophalangeal Joint: A New Surgical Technique With Patient Outcomes. Orthop J Sports Med. 2022 Dec 23;10(12):23259671221137558. doi: 10.1177/23259671221137558. PMCID: PMC9793050.
Level of Evidence: Level IV
Reviewed By: Michelle DeJesus, DPM
Residency Program: Lenox Hill Hospital, New York, NY
Podiatric Relevance: Plantar plate injury due to hyperextension of the first MTPJ, otherwise known as “turf toe,” is a common athletic injury treated by foot and ankle surgeons. When non-operative treatment is inadequate, it can lead to chronic problems and further delay in return to activity. When surgical treatment is indicated, an open approach is typically used. This study demonstrates a new arthroscopic procedure to repair chronic plantar plate tears of the first MTPJ and evaluate its effects on patient’s return to pre-injury activity and pain scores.
Methods: A retrospective case series evaluated the first 10 patients who underwent this arthroscopic repair of the 1st MTPJ plantar plate at a single institution between June 2017 and January 2021. The plantar plate was repaired arthroscopically through two portals, dorsomedial and dorsolateral to the EHL. An arthroscope and a shaver were first used to debride as needed, and a suture passing loop wire was then used to repair the plantar plate. Patient records were used to analyze clinical symptoms and findings and operative details. Patient reported outcome measures were obtained to analyze patient’s activity and pain levels following the procedure using the Manchester Oxford Foot Questionnaire for post-operative function and the Numeric Rating Scale for pain.
Results: The median final physical follow-up exam was at a median of 12 months post-operatively and the median follow-up for patient reported outcomes was 29 months post-operatively. Between 3-6 months post-operatively, all except 1 patient returned to the same level of activity as pre-injury. Complications included reduced skin sensation, minor reduced ROM of the joint compared to the contralateral side, and failure to fix the subtle valgus deformity. The median MOxFQ total score was 6 and the median NRS for pain was 0.
Conclusion: The high rate of return to activity and improvements in pain scores with the arthroscopic approach in this study were promising. Often when treating turf toe, failed non-operative treatment delays patients’ return to activity. Open surgical treatment further delays the return to sport which can have a negative impact on an athlete’s career. The introduction of an arthroscopic approach to this surgery can allow treatment of the injury with less healing time and earlier return to sport. This study was limited due to its small sample size and lack of pre-operative reported patient-reported scores for comparison. The surgical technique was also modified during the inclusion time of the study which may have varied the results. Further data is needed before these results may be generalized. The results from this study advocate for further use and advancements of this method for the treatment of this etiology. In athletes, where time for return to sport is crucial, surgical intervention may be considered sooner using arthroscopic approach when conservative measures are failing to improve symptoms.