Instruments and methods for complete plantar plate repairs

Abstract

Surgical repair systems and techniques for plantar plate repairs. The surgical repair systems and methods reconstruct the plantar plate through a dorsal incision. The surgical repair system embodies a variety of instruments that provide visualization and access to the plantar plate using suture to complete the repair. The repair system may include some or all of the following instruments: a metatarsal head pusher employed in open surgical space, to move the “capital fragment” in a controlled manner; a suture retriever instrument and a suture retriever funnel (sleeve); a suture passer such as a Mini Scorpion DX and accompanying needle, or a variety of shaped Micro Suture Lassos; a measuring guide; and a small joint distractor.

What is claimed is: 
     
         1 . A method of plantar plate repair, comprising the steps of:
 exposing a plantar tear of a plantar plate; and   repairing the plantar tear by employing at least one flexible strand.   
     
     
         2 . The method of  claim 1 , further comprising the step of reattaching the plantar plate to bone. 
     
     
         3 . The method of  claim 1 , wherein the step of exposing the plantar tear further comprises:
 performing a dorsal longitudinal incision to expose affected second metatarsophalangeal joint;   distracting the second metatarsophalangeal joint; and   conducting a metatarsal shortening osteotomy.   
     
     
         4 . The method of  claim 3 , wherein the step of distracting the second metatarsophalangeal joint is conducted by employing a metatarsal head pusher for moving the capital fragment while preventing damage to articular cartilage, and by employing a plantar plate distractor used with k-wires for distracting the second metatarsophalangeal joint. 
     
     
         5 . The method of  claim 3 , further comprising the steps of:
 passing the at least one flexible strand through the plantar plate to form a mattress stitch;   forming a plurality of holes through proximal phalanx; and   subsequently, passing the at least one flexible strand through the holes in the proximal phalanx to reattach the plantar plate to the proximal phalanx.   
     
     
         6 . The method of  claim 5 , wherein the step of forming a plurality of holes through the proximal phalanx comprises the steps of:
 inserting two k-wires into the proximal phalanx; and   drilling two parallel holes medially and laterally on the proximal phalanx, directed from a dorsal cortex of the proximal phalanx to the plantar rim of the proximal phalanx.   
     
     
         7 . The method of  claim 1 , wherein the flexible strand is suture. 
     
     
         8 . The method of  claim 7 , wherein the suture is formed of ultrahigh molecular weight polyethylene. 
     
     
         9 . A method of stabilizing the second metatarsophalangeal joint, comprising the steps of:
 performing a dorsal longitudinal incision to expose an affected second metatarsophalangeal joint;   distracting the affected second metatarsophalangeal joint to expose a plantar tear of a plantar plate;   performing a metatarsal shortening Weil osteotomy;   repairing the plantar tear by employing at least one suture and conducting a plurality of suture passes forming a mattress stitch on a distal end of the plantar tear;   subsequently, passing the at least one suture through a plurality of holes formed in the proximal phalanx to reattach the plantar plate to bone;   reducing the shortening Weil osteotomy; and   tying the at least one suture to the proximal phalanx.   
     
     
         10 . The method of  claim 9 , wherein the method is conducted by employing at least one instrument selected from the group consisting of a metatarsal head pusher for moving the capital fragment while preventing damage to articular cartilage, a measuring guide, a plantar plate distractor employed with k-wires for distracting the second metatarsophalangeal joint, k-wires employed with the plantar plate distractor, a suture passer instrument for passing at least one suture through the plantar plate, a suture retriever instrument for pulling suture through the plurality of holes formed within the proximal phalanx, and a suture retriever sleeve or funnel employed with the suture retriever instrument. 
     
     
         11 . A surgical kit for plantar plate repair, comprising:
 a metatarsal head pusher for moving the capital fragment while preventing damage to articular cartilage;   a measuring guide;   a plantar plate distractor employed with k-wires for distracting the second metatarsophalangeal joint;   k-wires employed with the plantar plate distractor;   a passer instrument for passing at least one flexible strand through the plantar plate;   a retriever instrument for pulling the at least one flexible strand through at least a bone tunnel formed within the proximal phalanx; and   a retriever sleeve or funnel employed with the retriever instrument.   
     
     
         12 . The surgical kit of  claim 11 , wherein the at least one flexible strand is suture. 
     
     
         13 . The surgical kit of  claim 12 , wherein the suture is formed of ultrahigh molecular weight polyethylene. 
     
     
         14 . A plantar plate repair comprising at least one suture extending between the plantar plate and the proximal phalanx. 
     
     
         15 . The plantar plate repair of  claim 14  further comprising an inverted mattress stitch on the plantar plate and at least one fixation device for Weil osteotomy on the metatarsal.