Radiofrequência artroscópica e osteotomia de weil para tratamento da instabilidade metatarsofalângica sutil dos pequenos dedos

Abstract

Introduction: several authors have demonstrated the importance of the plantar plate to stabilize the metatarsophalangeal joint (MTP) of the lesser toes. Until now, the literature only discusses how to treat extensive lesions of the plantar plate and collateral ligaments, with gross and obvious clinical instability. The early stages of disease with minor injuries and a subtle instability have no treatment options described. Objective: demonstrate the results obtained in the treatment of patients with plantar plate tear grade zero and one treated with arthroscopic radiofrequency of the plantar plate injuries combined with Weil osteotomy. Method: between January 2009 and June 2011, the data for 19 patients (35 joints) with instability of the lesser metatarsophalangeal were gathered. All had forefoot pain, subtle instability of the metatarsophalangeal joint and some degree of joint deformity. They underwent clinical, radiological and arthroscopic evaluation (diagnostic and therapeutic) of each affected joint and had their data recorded. The subtle instability, characterized by plantar plate tear grade 0 and 1, was defined by physical examination and confirmed with a diagnostic arthroscopy. Results: among our patients, 73% were female and 85% of then reported wearing high heels. The average age and postoperative follow-up was 59 years and 20 months, respectively. In the initial frame, 62% of joints showed spread toes with increased interdigital space. The American Orthopaedics Foot and Ankle Society score (AOFAS) and the Visual Analogue Pain Scale (VAS) showed statistically significant results (p <0.001): the mean AOFAS score rose from 53 points preoperatively to 92 points in the postoperatively and VAS obtained average value of eight points preoperatively which decreased to zero postoperatively. With the treatment instituted, we obtained pain relief, stability and joint congruity. During the preoperative evaluation, none of the patients had stable joint and over 97% were classified as having grade I of instability (<50% subluxation). After treatment, 83% of the metatarsophalangeal joints become stable (degree of instability 0) with over 97% of congruent joints. Conclusion: arthroscopic application of radiofrequency in combination with Weil osteotomy promotes functional improvement, pain relief and return of joint stability.