NOVEL SURGICAL METHODS FOR THE TREATMENT OF PLANTAR PLATE INJURY

Abstract

A method for the treatment of plantar plate injury including insertion of at least one suture anchor into a bone opening and anchoring the at least one suture anchor and thereafter threading two ends of a suture of at least one anchored suture anchor through the plantar plate and pulling the plantar plate to the bone with the opening and fix the soft tissue to that bone by tying a knot in the suture.

Claims

1. A method for the treatment of plantar plate injury comprising the following steps: performing a longitudinal dorsal, lateral or medial incision to expose a metatarsophalangeal joint, distracting the metatarsophalangeal joint to expose a plantar plate, inserting at least one suture anchor into a bone opening and anchoring the at least one suture anchor, threading two ends of a suture of at least one anchored suture anchor through the plantar plate, pulling the plantar plate to the bone with the opening and fix the soft tissue to that bone by tying a knot in the suture.

2. The method according to claim 1, wherein the at least one suture anchor comprises a material having thermoplastic properties and is anchored in the bone opening with the aid of vibratory energy used for in situ liquefaction of the material having thermoplastic properties.

3. The method according to claim 2, wherein threading two ends of a suture through the plantar plate includes passing the suture in a plantar to dorsal direction.

4. The method according to claim 1, wherein tying a knot in the suture includes tying the knot near a plantar phalangeal cortex of the phalangeal bone.

5. The method according to claim 4, wherein the bone opening is a blind hole.

6. The method according to claim 1, wherein the metatarsophalangeal joint is the joint of the second, third or fourth toe and the method comprises: performing a longitudinal dorsal incision to expose a metatarsophalangeal joint.

7. The method according to claim 1, wherein the metatarsophalangeal joint is the joint of the big or little toe and the method comprises: performing a longitudinal, lateral or medial incision to expose a metatarsophalangeal joint.

8. The method according to claim 1, wherein there is no need to pull the at least one anchor tight.

9. The method according to claim 1, wherein the at least one anchor is fully made of a bio-degradable material.

10. The method according to claim 1, wherein the at least one anchor is placed outside the articular surface.

11. The method according to claim 1, wherein the knot is placed outside the articular surface.

12. The method according to claim 1, comprising a Weil osteotomy of a distal epiphysis of the metatarsal of the exposed metatarsophalangeal joint.

13. The method according to claim 1, wherein the metatarsophalangeal joint is the joint of the big toe and the method comprises: performing a longitudinal medial incision to expose a metatarsophalangeal joint, distracting the metatarsophalangeal joint to expose a plantar plate, inserting at least two suture anchors into a bone opening and anchoring the at least one suture anchor, threading two ends of a suture of each anchored suture anchor through the plantar plate, pulling the plantar plate to the bone with the opening and fix the soft tissue to that bone by tying a knot in the suture.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0034] FIG. 1 shows a schematical overview of the foot with a hammer toe or contracted toe as a deformity of the proximal interphalangeal joint of the second toe causing it to be permanently bent.

[0035] FIG. 2 shows side view of a deformed proximal interphalangeal joint of the second toe causing it to be permanently bent.

[0036] FIG. 3 shows first steps of the method according to the invention including insertion and anchoring of a suture anchor and threading two ends of a suture of through the plantar plate.

[0037] FIG. 4 shows additional steps of the method according to the invention including repositioning the metatarsal head.

DETAILED DESCRIPTION OF THE INVENTION

[0038] The following more detailed description of the embodiments of the method is a representative of exemplary embodiments of the technology, wherein similar parts are designated by same numerals throughout. Standard medical planes of reference and descriptive terminology are employed in this specification. A sagittal plane divides a body into right and left portions. A transverse plane divides a body into superior and inferior portions. Anterior means toward the front of the body. Posterior means toward the back of the body. Superior means toward the head. Inferior means toward the feet. Medial means toward the midline of the body. Lateral means away from the midline of the body. Axial means toward a central axis of the body. Proximal means toward the trunk, or, in the case of an inanimate object, toward a user. Distal means away from the trunk, or, in the case of an inanimate object, away from a user. Dorsal means toward the top of the foot. Plantar means toward the sole of the foot. Ipsilateral means on the same side of the body. Contralateral means on the opposite side of the body.

[0039] FIGS. 1 and 2 illustrate the most important anatomical structures of a foot with a hammer toe (1) or contracted toe as deformity of the metatarsophalangeal joint (6) of the second toe causing it to be permanently bent. The metatarsophalangeal joints (6) are the joints between the metatarsal bones (2) of the foot and the proximal phalanges (3) of the toes. The great toe only has two phalanx bones (proximal and distal phalanges) and only one interphalangeal joint, which is often abbreviated as the IP joint. The rest of the toes each have three phalanx bones, the proximal (3), middle (4), and distal phalanges (5), so they have two interphalangeal joints. The plantar plate (8) is a rectangular, fibrocartilaginous structure overlying plantar aspects of metatarsophalangeal joints and is formed from distal parts of plantar aponeurosis and plantar aspects of metatarsophalangeal joint capsules.

[0040] An exemplary method of plantar plate repair employing a dorsal approach and combining a Weil osteotomy in accordance with the present invention is shown in the FIGS. 3 and 4. A dorsal longitudinal incision is centered over the second metatarsophalangeal joint (6). A longitudinal capsulotomy is performed to expose the affected second metatarsophalangeal joint (6). A partial collateral ligament release off of the proximal phalanx (3) of the metatarsophalangeal joint (6) may improve visualization. A metatarsal shortening osteotomy (Weil osteotomy, 9) is performed using a sagittal saw. The saw cut is made parallel to the plantar aspect of the foot. The capital fragment is provisionally pushed proximally and may be fixed with a temporary vertical Kirschner wire (k-wire), to hold it in a retracted position. A plantar plate distractor may be placed and spread to expose the plantar plate (8). The most common tear patterns of the plantar plate are partial and complete distal transverse tears at the distal insertion of the plantar plate. In case of partial transverse tear on should make the partial tear a complete tear as close as possible to the insertion of the plantar plate to the proximal phalanx (3). This reflects the plantar plate off the flexor tendon sheath.

[0041] A blind hole is created dorsal of the articulate surface on the proximal phalanx (plantar rim of the proximal phalanx). Thereafter a suture anchor (11) is inserted in the blind hole and anchored in a way that two free ends of the suture are accessible.

[0042] The distal plantar plate (8) is transfixed proximal to the transverse tear using, for example, a small curved needle or a suture passing instrument to pass the two free ends of the suture (10) through the plantar plate (8). As shown in FIG. 3 passing the suture (10) through the plantar plate occurs preferably, plantar to dorsal. When passed through the plantar plate, the suture tis pulled tight, thereby advancing the plantar plate onto the proximal phalanx (3). The suture (10) is then tied between the plantar plate (8) and the proximal phalanx (3). After removal of the joint distractor the phalanx is plantar flexed.

[0043] The distal plantar edge of the proximal phalanx may be roughened with a burr or curette to prepare a surface for re-implantation of the plantar plate. The metatarsal shortening (Weil) osteotomy (9) is moved to anatomic positioning, typically with 1-2 mm of shortening at the osteotomy site. It is fixed in optimal position with one or two small screws or k-wire. Wound closure is performed.

[0044] The inventor used the inventive method to treat some patients successfully. The fact that the suture does not have to be passed through bone tunnels meant considerable time savings around 15 to 20 minutes less per operation. In addition, he could observe that for the patients this new method involves less swelling and pain. This causes better and faster wound healing for all patients treated so far.

[0045] In addition it is suitable to use very small anchors such as the SportWelding Fiji Anchor. This together with the short suture and the less traumatic approach enable to treat also plantar plate injuries of the third to fifth toe using the methods of the present invention.