Patient-reported outcomes after dorsal approach plantar plate repair with nine year follow up.

Abstract

Despite reports of favorable short- and mid-term outcomes with direct plantar plate repair, there is scarce data in the literature with follow up greater than two years. To examine long-term clinical and patient-reported outcomes with isolated 2^nd metatarsophalangeal joint (MTPJ) dorsal approach plantar plate repair STUDY DESIGN: Prospective cohort of consecutive patients METHODS: Data were longitudinally collected from patients undergoing 2^nd MTPJ dorsal approach plantar plate repair for metatarsalgia in our practice from November 2011 to March 2012. Outcomes included a structured clinical assessment, VAS for pain and Foot and Ankle Outcome Scores (FAOS) at two years and 9+ years post-operatively. Fifty-three consecutive patients (53 joints; 50 women, 3 men) with mean age of 58.2 ± 9.8 years completed a two-year follow up exam demonstrating normalized toe position, strength, range of motion and stability. Eighteen patients developed post-operative dorsal joint arthrofibrosis and 16 elected for a minor percutaneous soft tissue release on the toe prior to this follow up visit. FAOS scores were significantly improved in 3 of 5 domains at two years. Thirty-two (32/53, 60%) patients completed assessments at a median 9.6 years post-operatively. At this time, scores were significantly improved from both baseline and 2 years in all 5 FAOS domains. Seventy-eight percent (25/32) of patients reported they were satisfied or extremely satisfied and would have the procedure again. The 2^nd MTPJ dorsal approach plantar plate repair appears to be safe and effective at alleviating pain and restoring function at long-term follow up. Therapeutic level 4.