Plantar plate radiofrequency and Weil osteotomy for subtle metatarsophalangeal joint instablity

Abstract

BackgroundTo the present day, literature has only discussed how to treat extensive plantar plate and collateral ligament lesions, with gross joint subluxation and obvious clinical instability. The treatment options for early stages of the disease with minor injuries and subtle instabilities have not been described. The main purpose of this prospective study is to evaluate the efficacy of the combination of the arthroscopic radiofrequency shrinkage and distal Weil osteotomy in the treatment of subtle metatarsophalangeal joint instability.MethodProspective data (clinical, radiological, and arthroscopic findings) of 19 patients, with a total of 35 slightly unstable joints, was collected. The physical examination defined the hypothesis for plantar plate lesions (grades 0 and 1), which was confirmed during the diagnostic step of the arthroscopic procedure.ResultsAmong our patients, 73 % were females and 63 % reported wearing high heels. The average age was 59 years and post-operative follow-up was 20 months. In the initial sample frame, 62 % of joints showed spread-out toes with increased interdigital spacing. The mean American Orthopedic Foot and Ankle Society score rose from 53 points pre-operatively to 92 points post-operatively and a visual-analog pain scale average value of eight points pre-operatively decreased to zero post-operatively. During the pre-operative evaluation, none of the patients had stable joints and over 97 % were classified as having grade 1 instability (<50 % subluxation). After treatment, 83 % of the joints became stable (degree of instability 0) and over 97 % were congruent. All studied parameters showed statistically significant improvements in the post-operative period (p < 0.001) showing the efficiency of the treatment in pain relief, while restoring the joint stability and congruity.ConclusionArthroscopic radiofrequency shrinkage in combination with distal Weil osteotomy promotes functional improvement, pain relief, and restores the joint stability in the plantar plate lesion grades 0 and 1.

Etiology, Clinical Assessment, and Surgical Repair of Plantar Plate Tears

“…Following the clinical and radiologic assessment, final staging of the plantar plate tear is determined arthroscopically. 19,25,26 Arthroscopic evaluation of the lesser MTP joint is performed under a regional block and sedation in a supine position with a tourniquet at shin or thigh level. After synovectomy of the affected joint, grade 0 and 1 plantar plate lesions are treated with radiofrequency shrinkage (Arthro-Care Short Bevel, 25 degrees, 2.3 mm, Andover, MA, USA).…”

“…Finally, Weil osteotomy via a dorsal approach using a sagittal saw is performed to achieve a harmonic anatomical relationship between the metatarsal heads (metatarsal parabola). 25 Grade II and III tears are directly repaired and reinserted onto the plantar margin of the proximal phalanx via a dorsal approach (►Fig. 8).…”

“…These results suggest that surgical treatment of MTP joint instability in the early stages might yield better outcomes. 25…”

Lesser Metatarsophalangeal Instability: Diagnosis and Conservative Management of a Common Cause of Metatarsalgia

“…Lesser MTP instability affects the second, third, and fourth MTP joints and is often bilateral. 27,32 Of these joints, the second MTP is the most commonly affected. 30,38-40 Women and the elderly are the populations at highest risk.…”

“…30,38-40 Women and the elderly are the populations at highest risk. 4,13,27,30,32 The age range is wide, with a mean age of 60 years in the general population and 50 years in the athletic population. 2,4,5,13,22,32 Athletes and active patients comprise 26% to 79% of cases depending on the clinic.…”