aofas meeting 2012 san diego, ca radiographic · pdf filestatistical testing performed was a...

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


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.


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


Hypothesis

A quantitative evaluation of turf toe injury is possible

via radiographic analysis by measuring the relationship between capsuloligamentous injury and

sesamoid movement.


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


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


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.


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


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


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.

aofas meeting 2012 san diego, ca radiographic · pdf filestatistical testing performed was a...

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