Reconstruction of the plantar plate of the metatarsophalangeal joint using a dorsal transarticular approach

OBJECTIVE Reconstruction of the plantar plate to stabilize a dislocated or instable lesser metatarsophalangeal joint using a dorsal approach in combination with a Weil osteotomy. INDICATIONS Dislocated or instable lesser metatarsophalangeal joint with rupture of the plantar plate. CONTRAINDICATIONS Infection, circulatory disorders, symptomatic degenerative arthritis lesser metatarsophalangeal joint. SURGICAL TECHNIQUE Weil osteotomy using a dorsal approach. Temporary dislocation of the metatarsal head as proximal as possible. Inspection of the plantar plate. Assessment and classification of type and extent of the rupture. Suturing of the plantar plate to the plantar bases of the proximal phalanx. Fixation of the Weil osteotomy with correction of the metatarsal alignment. POSTOPERATIVE MANAGEMENT Weight bearing in a postoperative shoe as tolerated. X‑ray control 6 weeks postoperative. Full weight bearing in a conventional shoe after bony consolidation. RESULTS A total of 23 surgical reconstructions of the plantar plate (complete plantar plate repair) between 12/2012 and 10/2014 were performed. The mean follow-up was 18.6 (12-30) months. Five secondary dislocations were observed: one deep postoperative infection, one early dislocation of unknown cause, one secondary dislocation caused by severe hallux valgus recurrence, one massive foreign body reaction to the non-resorbable sutures, and one late secondary dislocation occurred between 6 weeks and 1 year postoperative. Normal function of the reconstructed joint was achieved in 13 of the 23 reconstructions (57%). A reduced toe purchase was observed in 3 reconstructions (13%). A floating-toe resulted after 7 reconstructions (30%).