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Copyright © 2011 Steadman Philippon Research Institute
Radiographic Evaluation of Plantar Plate Injury: An In Vitro Biomechanical Study
Norman E. Waldrop, III, MD Chris Zirker, MS
Coen A. Wijdicks, PhD Robert A. Laprade, MD, PhD
Thomas O. Clanton, MD
The Steadman Clinic June 2012
AOFAS Meeting 2012 San Diego, CA
Copyright © 2011 Steadman Philippon Research Institute
Radiographic Evaluation of Plantar Plate Injury: An In Vitro Biomechanical Study
Norman E. Waldrop, III, MD
My disclosure is in the Final AOFAS Program Book.
I have no potential conflicts with this presentation.
Copyright © 2011 Steadman Philippon Research Institute
Turf Toe: Introduction
Debilitating condition with a broad spectrum of symptoms
Prior studies have demonstrated a qualitative relationship between the movement of the sesamoid bones and turf toe injuries
No effort has been made to quantify the changes in movement of the sesamoids with respect to the extent of injury
Copyright © 2011 Steadman Philippon Research Institute
Hypothesis
A quantitative evaluation of turf toe injury is possible
via radiographic analysis by measuring the relationship between capsuloligamentous injury and
sesamoid movement.
Copyright © 2011 Steadman Philippon Research Institute
Methods
24 Fresh Frozen Specimens
The four structures of the plantar plate capsuloligamentous complex were cut in four different orders
Lateral flouroscopic images taken with each cut
Copyright © 2011 Steadman Philippon Research Institute
Methods
Standardized dorsiflexion stress with 15 N at 45°to floor
Surgeon performed manual dorsiflexion stress test
Statistical testing performed was a repeated measures ANOVA with Tukey post hoc
Copyright © 2011 Steadman Philippon Research Institute
Results
No differences between the four groups for each cut
The third ligament cut was statistically significant compared to the intact state
N: 24 Specimens Cut 1 Cut 2 Cut 3 Cut 4
Surgeon 0.08 1.20 3.04* 6.96* Standard 0.68 1.53 3.37* 7.89* Measurements in millimeters (mm) Δ from intact state
* Statistically significant p≤0.05
Intraobserver intraclass correlation between Surgeon and Standardized groups for each observer was 0.95
Interobserver intraclass correlation for radiographic measurements of the phalangeal sesamoid distances for surgeon group and the standardized group was 0.94 and 0.88, respectively.
Copyright © 2011 Steadman Philippon Research Institute
Discussion
A 3mm difference in movement of the sesamoids compared to the intact state after turf toe injury is highly predictive of a three ligament injury
Study identifies more severe injuries that could lead to instability of the joint
Copyright © 2011 Steadman Philippon Research Institute
Conclusion First study to quantify change in excursion
based on the extent of ligamentous injury
Study aids in identifying those patients who need more advanced imaging, i.e. MRI
Aids in diagnosing more severe turf toe injuries
Guide the clinician in treatment decisions
Copyright © 2011 Steadman Philippon Research Institute
References
Bowers KD Jr, Martin RB. Turf-Toe: a shoe-surface related football injury. Med Sci Sports. 1976;8(2):81-83.
Clanton TO, Butler JE, Eggert A. Injuries to the metatarsophalangeal joints in athletes. Foot Ankle. 1986;7(3):162-176.
Clanton TO, Ford JJ. Turf Toe Injury. Clin Sports Med. 1994;13(4):731-741. McCormick JJ, Anderson RB. Rehabilitation following turf toe injury and plantar
plate repair. ClinSports Med. 2010; 29(2):313-23. McCormick JJ, Anderson RB. The great toe: failed turf toe, chronic turf toe, and
complication of sesamoid injuries. Foot Ankle Clin. 2009;14(2):135-50. Prieskorn D, Graves SC, Smith RA. Morphometric analysis of the plantar plate
apparatus of the first metatarsophalangeal joint. Foot Ankle. 1993;14(4):204-207. Rodeo SA, O'Brien S, Warren RF, Barnes R, Wickiewicz TL, Dillingham MF. Turf-
toe: an analysis of metatarsophalangeal joint sprains in professional football players. Am J Sports Med. 1990;18(3):280-5.