MRI and plantar plate dysfunction

NewsBot · Jun 26, 2012

Members do not see these Ads. Sign Up.
Diagnosis of Plantar Plate Injury by Magnetic Resonance Imaging with Reference to Intraoperative Findings
Wenjay Sung, Lowell Weil Jr., Lowell Scott Weil Sr., Richard J. Rolfes
Journal of Foot and Ankle Surgery, Article in Press

The objective of the present study was to assess the utility of magnetic resonance imaging in evaluating injury to the plantar plate and to determine whether conventional low-field magnetic resonance imaging is a valid tool for diagnostic evaluation. Magnetic resonance imaging scans of 45 feet in 41 patients (38 females and 3 males, with an average age of 52.1 years) were prospectively evaluated to assess the integrity of the plantar plate ligament and compared with a reference standard of intraoperative findings. The concordance of tear severity observed on magnetic resonance imaging with the intraoperative findings was also assessed using a newly proposed grading scheme for plantar plate injuries. Intraoperatively, 41 plantar plate tears and 4 intact ligaments were found. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value was 96%, 95%, 100%, 100%, and 67%, respectively. The clinical diagnosis of plantar plate injury was also highly accurate in our study population (41/45, 91%). Finally, we observed moderate concordance between the magnetic resonance imaging grade and surgical grade of plantar plate tear (28/45, 62%), with greater concordance occurring at higher grades. Our results have demonstrated that magnetic resonance imaging is an accurate and valid test for the diagnosing injuries of the plantar plate ligament. Given the high accuracy of the clinical findings, magnetic resonance imaging is most useful when the decision to operate will be sufficiently influenced by either a normal magnetic resonance imaging appearance of the plantar plate or the presence of a high-grade tear.
Click to expand...

PodAus · Jun 26, 2012

How's MR compare to MSU %?

Admin2 · Jun 26, 2012

Related threads:
Other threads tagged with plantar plate

Admin2 · Mar 21, 2013

MRI Evaluation of the MTP Plantar Plates Compared With Arthroscopic Findings
A Prospective Study
Caio Nery et al
Foot & Ankle International March 2013 vol. 34 no. 3 315-322

Background: Instability of the lesser metatarsophalangeal (MTP) joints has been widely reported and plantar plate insufficiency is a key part of this pathologic process. The diagnosis is made clinically but can be aided by imaging studies, particularly magnetic resonance imaging (MRI); however, the sensitivity and accuracy of this method compared to direct visualization of these lesions has not yet been established, nor has interobserver accuracy of MRI been assessed for evaluation of plantar plate pathology. In this study, our goals were to identify the accuracy of the MRI in describing plantar plate tears when compared to direct arthroscopic visualization using an anatomic grading system and to test the influence of an anatomic grading system in the accuracy of the MRI readings.

Methods: We evaluated the clinical exam, MRI scans, and arthroscopic findings of 35 patients with lesser MTP instability.

Results: Using an anatomic grading system, a distinct improvement in the radiological evaluation and interpretation occurred. Knowledge of the pattern of plantar plate tears by a radiologist enabled them to locate and describe the type of tears of the plantar plate on the MRI. The amount of training and the experience of the radiologist were also important factors in our study. The senior radiologists had much better levels of accuracy (Group A, 77.0%; Group B, 88.5%) than less experienced radiologists.

Conclusion: Prior knowledge of the pathophysiology and morphological types of lesions of the plantar plates was helpful for accurate identification and description of the tears by the radiologist.
Click to expand...

NewsBot · Apr 5, 2013

Musculoskeletal Ultrasound for Preoperative Imaging of the Plantar Plate
A Prospective Analysis
Erin E. Klein, DPM, MS; Lowell Weil Jr, DPM, MBA; Lowell Scott Weil Sr, DPM; Jessica Knight, DPM
Foot Ankle Spec April 4, 2013

The purpose of this study was to prospectively compare preoperative findings on musculoskeletal ultrasound evaluation to observed intraoperative findings for patients undergoing surgical correction of plantar plate tears. Fifty consecutive patients with forefoot pain and a suspected unilateral plantar plate tear at the second metatarsophalangeal (MTP) joint were identified. The same examiner performed a 2-plane (longitudinal and transverse) musculoskeletal ultrasound on the painful second MTP joint. The contralateral second MTP joint was used for comparison. Longitudinal ultrasound images were graded as “torn” or “intact.” Transverse ultrasound images were used to localize the suspected pathology. Results of the ultrasound were compared with observed intraoperative pathology. Forty-five plantar plate tears were identified intraoperatively. Longitudinal ultrasound images correctly identified 40 plantar plate tears. The longitudinal ultrasound had a sensitivity of 91.1%, a specificity of 25%, a positive predictive value of 91.1%, and a negative predictive value of 25%. Transverse ultrasound images identified 36 plantar plate tears correctly localizing only 19 tears. Musculoskeletal ultrasound has been widely used to identify and localize pathology in many soft tissue structures. Whereas the longitudinal ultrasound images were useful in identifying plantar plate tears, the same cannot be said about the ability to localize the tear on the transverse ultrasound images. Therefore, ultrasound may not be as good an imaging modality as magnetic resonance imaging for identification and localization of plantar plate pathology.
Click to expand...

PodAus · Apr 8, 2013

gets back to Kevins article on clinical skills...
except applying to musculoskeletal Radiologists & Sonographers....

MSU is very dependent upon the skills of the Sonographer and the reporting Radiologist. MR is dominent modailty and very accessible in US.

We're all creatures of habit...

NewsBot · Jun 2, 2014

MRI of lesser metatarsophalangeal joint plantar plate tears and associated adjacent interspace lesions.
Umans H, Srinivasan R, Elsinger E, Wilde GE.
Skeletal Radiol. 2014 Jun 1.

OBJECTIVE:
To identify the variety of second and third intermetatarsal space (IS) lesions that may coexist with and without adjacent metatarsophalangeal joint (MTP) plantar plate (PP) tears.
MATERIALS AND METHODS:
One hundred forefoot MRIs in 96 patients with metatarsalgia obtained between 30 September 2011 and 21 July 2012 using 1.5- or 3-T MRI were retrospectively reviewed in consensus by two MSK radiologists and one podiatrist (DPM). MRI was evaluated for second and third MTP PP tear and the presence/nature of second and third IS lesions. Second and third IS neuromas were measured in transverse (trans) dimension.
RESULTS:
A total of 40 PP tears were identified: 36 at the second and 4 at the third MTP. Second MTP PP tear was identified in 33 % of females and 40.5 % of males. In the 63 female feet there were 21 second MTP PP tears, all of which also had second IS lesions: pericapsular fibrosis (16), bursitis (4), and ganglion (1). In the 37 male feet there were 15 second MTP PP tears, 14 of which had second IS lesions: pericapsular fibrosis (8), bursitis (5), and ganglion (1). There was no definite second IS neuroma adjacent to any second MTP PP tear. In females without PP tear, there were 24 second (3 mm trans average) and 43 third IS neuromas (4.1 mm trans average). In males without PP tear, there were 9 second (3.4 mm trans average) and 16 third IS neuromas (4.1 mm trans average).
CONCLUSIONS:
MTP PP tears occurred in 40 % of our cases, 90 % of which occurred at the second MTP. Almost all coexisted with non-neuromatous second IS lesions.
Click to expand...

NewsBot · Apr 12, 2016

Predictive MRI correlates of lesser metatarsophalangeal joint plantar plate tear
Rachel L. Umans, Benjamin D. Umans, Hilary Umans , Elisabeth Elsinge
Skeletal Radiology; 07 April 2016

Purpose
To identify correlated signs on non-enhanced MRI that might improve diagnostic detection of plantar plate (PP) tear.
Materials and methods
We performed an IRB-approved, HIPAA-compliant retrospective analysis of 100 non-contrast MRI (50 PP tear, 50 controls). All were anonymized, randomized, and reviewed; 20 were duplicated to assess consistency. One musculoskeletal radiologist evaluated qualitative variables. A trained non-physician performed measurements.
Consistency and concordance were assessed. Pearson’s Chi-square test was used to test the correlation between qualitative findings and PP tear status. Correlation between measurements and PP status was assessed using t tests and Wilcoxon’s rank-sum test (p values < 0.05 considered significant). Classification and regression trees were utilized to identify attributes that, taken together, would consistently distinguish PP tear from controls.
Results
Quantitative measurements were highly reproducible (concordance 0.88–0.99). Elevated 2nd MT protrusion, lesser MT supination and rotational divergence of >45? between the 1st–2nd MT axis correlated with PP tear.
Pericapsular soft tissue thickening correlated most strongly with PP tear, correctly classifying 95 % of cases and controls. Excluding pericapsular soft tissue thickening, sequential assessment of 2nd toe enthesitis, 2nd flexor tendon subluxation, and splaying of the second and third toes accurately classified PP status in 92 %.
Conclusions
Pericapsular soft tissue thickening most strongly correlated with PP tear. For cases in which it might be difficult to distinguish pericapsular fibrosis from neuroma, sequential assessment of 2nd toe enthesitis, flexor tendon subluxation and splaying of the 2nd and 3rd toe is most helpful for optimizing accurate diagnosis of PP tear.
Click to expand...

NewsBot · Jan 24, 2017

Role of magnetic resonance imaging versus ultrasound for detection of plantar plate tear.
Duan X et al
J Orthop Surg Res. 2017 Jan 21;12(1):14. doi: 10.1186/s13018-016-0507-6.

BACKGROUND:
Plantar plate tears could be the reason of forefoot pain, affecting foot function. Magnetic resonance imaging (MRI) and ultrasound (US) were commonly used for the diagnosis of plantar plate tears. The decision of whether to use MRI or US carried some controversy. Our study aimed to find out the diagnostic accuracy of MRI versus US for plantar plate tears.
METHODS:
The database of the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, and relative orthopedic meetings until May 2016 were searched. Studies involved in the diagnostic detection of MRI or ultrasound for plantar plate tears with surgical criteria as the reference test were included. Data was analyzed by meta-analysis. We compared sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and summary receiver operating characteristic (sROC) plot of both MRI and US.
RESULTS:
Seven studies involving 246 plantar plate tears were included. The MRI showed more diagnostic accuracy than US for the detection of plantar plate tears. The sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of MRI were 95%, 54%, 2.08, and 0.08, respectively, while the same values for US were 93%, 33%, 1.20, and 0.35, respectively. And the sROC showed more superior diagnostic accuracy than the US.
CONCLUSION:
The current result suggests that MRI has better accuracy than US for detection of plantar plate tears.
Click to expand...

NewsBot · Feb 25, 2017

Comparing Magnetic Resonance Imaging and High-Resolution Dynamic Ultrasonography for Diagnosis of Plantar Plate Pathology: A Case Series
Ryan J. Donegan et al
The Journal of Foot and Ankle Surgery; Volume 56, Issue 2, March–April 2017, Pages 371–374

Plantar plate pathology has gained noticeable attention in recent years as an etiology of lesser metatarsophalangeal joint pain. The heightened clinical awareness has led to the need for more effective diagnostic imaging accuracy. Numerous reports have established the accuracy of both magnetic resonance imaging and ultrasonography for the diagnosis of plantar plate pathology. However, no conclusions have been made regarding which is the superior imaging modality. The present study reports a case series directly comparing high-resolution dynamic ultrasonography and magnetic resonance imaging. A multicenter retrospective comparison of magnetic resonance imaging versus high-resolution dynamic ultrasonography to evaluate plantar plate pathology with surgical confirmation was conducted. The sensitivity, specificity, and positive and negative predictive values for magnetic resonance imaging were 60%, 100%, 100%, and 33%, respectively. The overall diagnostic accuracy compared with the intraoperative findings was 66%. The sensitivity, specificity, and positive and negative predictive values for high-resolution dynamic ultrasound imaging were 100%, 100%, 100%, and 100%, respectively. The overall diagnostic accuracy compared with the intraoperative findings was 100%. The p value using Fisher's exact test for magnetic resonance imaging and high-resolution dynamic ultrasonography was p = .45, a difference that was not statistically significant. High-resolution dynamic ultrasonography had greater accuracy than magnetic resonance imaging in diagnosing lesser metatarsophalangeal joint plantar plate pathology, although the difference was not statistically significant. The present case series suggests that high-resolution dynamic ultrasonography can be considered an equally accurate imaging modality for plantar plate pathology at a potential cost savings compared with magnetic resonance imaging. Therefore, high-resolution dynamic ultrasonography warrants further investigation in a prospective study.
Click to expand...

NewsBot · Jan 15, 2021

Ultrasound findings of plantar plate tears of the lesser metatarsophalangeal joints
Catherine L. McCarthy & Graeme V. Thompson
Skeletal Radiology (2021)

Lesser metatarsophalangeal (MTP) joint plantar plate tears are a common and increasingly recognised cause of metatarsalgia, MTP joint instability and forefoot deformity. Increased interest in early accurate diagnosis of plantar plate tears follows recent surgical innovations allowing direct plantar plate repair. The purpose of this review is to describe the ultrasound features of normal lesser MTP joint plantar plates and to characterise and illustrate the direct and indirect ultrasound findings of plantar plate tears. Lesser MTP joint plantar plate tears are most commonly located at the 2nd MTP joint, involving the lateral distal plantar plate insertion with variable propagation medially and proximally. The most common ultrasound appearance of a plantar plate tear is a discrete partial or full thickness hypoechoic defect in the plate substance. Flattening and attenuation or non-visualisation of the plantar plate represent more extensive tears. Dynamic imaging with toe dorsiflexion improves visualisation of tears and augments MTP joint subluxation. A common indirect finding is pericapsular fibrosis along the MTP joint capsule adjacent to a plantar plate tear, which requires differentiation from Morton’s neuroma, and key distinguishing features at ultrasound are described. Other indirect findings include the cartilage interface sign, flexor tendon subluxation onto the metatarsal head or medial to the midline, flexor tenosynovitis, proximal phalangeal enthesophytes or avulsion and MTP joint synovitis. Ultrasound offers several advantages over MR imaging but requires a meticulous ultrasound examination, and optimisation of scanning technique is described.
Click to expand...

NewsBot · Apr 20, 2022

Degenerative injuries of the metatarsophalangeal plantar plate on magnetic resonance imaging: a new perspective
Tania Szejnfeld Mann et al
Einstein (Sao Paulo). 2022; 20: eAO6543.

Objective
The magnetic resonance imaging diagnostic criteria for a complete tear of metatarsophalangeal plantar plate are well-established. However, more subtle abnormalities can also occur and be a source of pain. The objective of this study is to determine the prevalence of degenerative plantar plate injuries in patients with metatarsalgia who underwent forefoot magnetic resonance imaging and describe the main abnormalities found. The hypothesis is that mild capsular fibrosis will have high sensitivity but low specificity for plantar plate degenerative injuries.

Methods
A retrospective cross-sectional study was conducted with 85 patients (105 feet) with metatarsalgia who underwent forefoot magnetic resonance imaging using a specific protocol to study metatarsophalangeal plantar plate. The experiment observer classified second toe plantar plate as normal, complete rupture or degenerative lesion and described the main magnetic resonance imaging findings.

Results
A normal plantar plate was observed in 75 (71.4%) of the 105 feet assessed, in 25 (24%) feet there were degenerative plantar lesions, and in 5 (4.6%) feet there were complete ruptures. Degenerative injury of the plantar plate was best identified in coronal short axis intermediate-weighted images, with high sensitivity (92%). Pericapsular fibrosis below the intermetatarsal ligament was identified in 96% of cases, with high sensitivity (96%) for diagnosis of degenerative plantar plate injury.

Conclusion
Degenerative lesions of the metatarsophalangeal plantar plate were more prevalent than complete ruptures and were best viewed in coronal short axis intermediate-weighted sequences. Pericapsular fibrosis below the intermetatarsal ligament was the indirect finding most strongly associated with degenerative plantar plate injury.
Click to expand...

NewsBot · May 3, 2022

Diagnostic Accuracy of Magnetic Resonance Imaging (MRI) Versus Dynamic Ultrasound for Plantar Plate Injuries: A Systematic Review and Meta-Analysis
Rachel H.Albright et al
European Journal of Radiology; 30 April 2022, 110315

Highlights
•MRI displayed a pooled sensitivity of 89% (95% CI 0.84, 0.93) and specificity of 83% (95% CI 0.64, 0.94). Ultrasound displayed a sensitivity and specificity of 95% (95% CI 0.91, 0.98) and 52% (95% CI 0.37, 0.68), respectively.
•This systematic review with meta-analysis demonstrated that MRI was superior to ultrasound in diagnosing plantar plate injuries overall, however, ultrasound was more sensitive than MRI, suggesting a negative ultrasound would likely rule out a plantar plate injury with an equivocal physical exam.
Click to expand...

Background
Previous literature has suggested both MRI and ultrasound can accurately diagnose plantar plate tears. There is a significant cost difference between these two modalities, sparking interest for which should be the preferred method for diagnosis.

Purpose
The purpose of this study was to examine the diagnostic accuracy of MRI and dynamic, musculoskeletal ultrasound for diagnosing lesser metatarsal plantar plate injuries using a systematic review and meta-analysis.

Methods
MEDLINE, CINAHL, and Clinicaltrials.gov were searched thru May 2020. We included studies evaluating the diagnostic accuracy of MRI or ultrasound for detecting plantar plate tears, using intraoperative confirmation as the gold standard comparison. Sensitivity and specificity were obtained and pooled from included studies. Summary receiver operating curves were formed for each diagnostic test to compare accuracy. Study quality was assessed using the QUADAS-2 scoring system.

Results
Ten studies met our inclusion criteria, representing 227 plantar plates for MRI and 238 plantar plates for ultrasound. MRI displayed a pooled sensitivity of 89% (95% CI 0.84, 0.93) and specificity of 83% (95% CI 0.64, 0.94). Ultrasound displayed a sensitivity and specificity of 95% (95% CI 0.91, 0.98) and 52% (95% CI 0.37, 0.68), respectively.

Conclusion
MRI was superior to ultrasound in diagnosing plantar plate injuries overall, however, ultrasound was more sensitive than MRI, suggesting a negative ultrasound would likely rule out a plantar plate injury in the presence of an equivocal physical exam. Determining the grade of the injury is best served with MRI which can provide added insight into the joint’s supporting structures (e.g. collateral ligaments) and integrity.
Click to expand...

NewsBot The Admin that posts the news.

PodAus Active Member

Admin2 Administrator Staff Member

Admin2 Administrator Staff Member

NewsBot The Admin that posts the news.

PodAus Active Member

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Is There a Role for MRI in Plantar Heel Pain

MRI predicts response to shockware therapy in plantar fassciitis

Did the MRI lie? Plantar fasciitis but no pain

Disorders of the Plantar fascia MRI pictorial Review

Weightbearing MRI for plantar fasciitis

Unnecessary MRI in ankle ligament injuries?

MRI features in asymptomatic amateur marathon runners

Share This Page