Indications and possible limitations using medio-plantar plate systems in tarsometatarsal 1 fusions - A cadaveric study

Philipp Winter; Kajetan Klos; Laura Lambert; Friedrich Paulsen; Stefan Landgraeber; Joe Wagener

doi:10.1016/j.aanat.2023.152145

Indications and possible limitations using medio-plantar plate systems in tarsometatarsal 1 fusions - A cadaveric study

Ann Anat. 2023 Oct:250:152145. doi: 10.1016/j.aanat.2023.152145. Epub 2023 Aug 18.

Authors

Philipp Winter¹, Kajetan Klos², Laura Lambert³, Friedrich Paulsen⁴, Stefan Landgraeber³, Joe Wagener⁵

Affiliations

¹ Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany. Electronic address: philipp.winter@uks.eu.
² Department of Trauma-, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany; Gelenkzentrum Rhein-Main, Fuß- Und Sprunggelenkschirurgie, Frankfurter Straße 94, 65239 Hochheim, Germany.
³ Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany.
⁴ Institute of Functional and Clinical Anatomy, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany.
⁵ Department of Orthopaedic Surgery, University of Saarland, Kirrberger Straße, 66421 Homburg, Germany; Department of Orthopaedic Surgery, Hôpital Kirchberg, L-2540 Luxembourg, Germany.

PMID: 37597823
DOI: 10.1016/j.aanat.2023.152145

Abstract

Background: The tarsometatarsal 1 arthrodesis is an adequate treatment for moderate to severe hallux valgus deformity and instability of the first ray. Plantar plating arthrodesis has been shown to provide better mechanical stability and fewer postoperative complications than screw fixation or medial plating. The medio-plantar plate is a new plate design for Lapidus arthrodesis. It could combine the biomechanical advantages of the plantar plate and the anatomical overview of a medial plate. However, the implanted material can cause irritation of the tibialis anterior, which in some cases may require removal of the material. The purpose of this study was to examine the possibility of tendon irritation following medio-plantar first tarsometatarsal joint arthrodesis using cadaveric specimens.

Methods: The study involved the simulated surgical procedure of medio-plantar plate arthrodesis on 30 lower extremities. After the plates were fixed, a thorough examination of the feet was conducted to assess any tendon irritation and to determine a recommendation for placement of the medio-plantar plate based on the Olewnik classification.

Results: Irritation of the tibialis anterior tendon components with the medio-plantar plate depends mainly on the anatomic norm variant, classified according to Olewnik et al. A medio-plantar plate is particularly recommended in TA tendon Olewnik type 3 and type 5. The positioning of a medio-plantar plate in Olewnik type 1 and type 2 tendons depends on the anatomic fit of the medio-plantar plate and the bony configuration of the TMT 1 joint. A large portion of the TA tendon must be detached, so a different plate design may be preferred in these patients.

Conclusions: TMT 1 arthrodesis with medio-plantar plating of the first tarsometatarsal joint should be performed considering the anatomic TA tendon variations.

Level of evidence: Level V, Expert Opinion includes Case Reports and Technique Tips.

Keywords: Hallux valgus; Lapidus; Medio-plantar plate; Plantar plate; Tarsometatarsal arthrodesis; Tendon irritation; Tibialis anterior.

MeSH terms

Arthrodesis / methods
Cadaver
Hallux Valgus* / surgery
Humans
Plantar Plate* / surgery
Tendons