Direct Plantar Approach to Plantar Plate Repair and Associated Wound Complications

Area of Science:

• Orthopedic surgery
• Foot and ankle reconstruction

Background:

• Lesser toe metatarsophalangeal joint (MTPJ) instability often results from plantar plate tears.
• Surgical repair is commonly performed via a dorsal approach, but a direct plantar approach allows for direct ligamentous or bone repair.
• Previous studies show success with both approaches, but the safety of the plantar incision requires further investigation.

Purpose of the Study:

• To evaluate the safety and efficacy of the direct plantar approach for plantar plate repairs (PPRs).
• To report the complication rates associated with plantar incisions in a large clinical series.

Main Methods:

• Retrospective review of 204 PPRs in 185 patients (194 lesser MTP, 10 hallux MTP).
• Surgical repair utilized absorbable braided suture or suture anchors, with or without MTPJ pinning.
• Complications included superficial/deep infection, painful scars, and reoperation. Risk factors like diabetes, tobacco use, and neuropathy were analyzed.

Main Results:

• Overall complication rate was 15% (14 superficial infections, 17 painful scars, 3 reoperations).
• No deep infections occurred. No increased complications were seen with suture anchors, MTPJ pinning, neuropathy, or diabetes.
• Tobacco use significantly increased the odds of any wound complication (OR 7.5) and superficial infection (OR 9.8).

Conclusions:

• The direct plantar approach for PPR is clinically viable with low complication and minimal reoperation rates.
• This approach demonstrates safety and efficacy for plantar plate repairs, particularly for direct repairs.
• Plantar-based incisions are a safe option for PPR, with tobacco use being a notable risk factor.