Exposure via Sequential Release of the Metatarsophalangeal Joint for Plantar Plate Repair Through a Dorsal Approach Without an Intraarticular Osteotomy

Background: Traditionally, plantar plate repairs have been performed from either a direct plantar approach or through a dorsal approach utilizing an intraarticular metatarsal osteotomy. It is unknown if a plantar plate repair can be reliably performed through a dorsal approach without an osteotomy. Methods: The second through fourth metatarsal phalangeal (MTP) joints of 4 fresh frozen cadavers were sequentially dissected and the exposure of the plantar plate was quantified with a digital micrometer. A suture passer was then utilized to pass a suture through the released plantar plate without a metatarsal osteotomy. Results: The mean plantar plate exposure after capsulotomy was 1.1 mm, after capsulotomy and release of the collateral ligaments exposure was 2.5 mm, after the addition of a release of plantar structures with a McGlamry elevator exposure was 4.1 mm, and after the addition of a plantar plate takedown the exposure was 5.3 mm. Every specimen had a minimum of 4 mm of exposure. Two sutures were successfully passed through every plantar plate with the exposure obtained. Conclusion: Significant improvement in exposure of the plantar plate was achieved with each successive structure released.