US20130184818A1 - Instruments and methods for complete plantar plate repairs - Google Patents

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.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application claims the benefit of U.S. Provisional Application No. 61/583,915 filed Jan. 6, 2012, the disclosure of which is incorporated by reference in its entirety herein.
FIELD OF THE INVENTION
• The present invention relates to surgical devices and methods, and more particularly, to systems and methods for complete plantar plate repairs.
BACKGROUND OF THE INVENTION
• The second metatarsophalangeal (MTP) joint is stabilized by a combination of static resistance provided by the plantar plate and collateral ligaments, and the dynamic pull of the intrinsic flexors. The plantar plate is rectangular to trapezoidal and originates on the metatarsal head through a thin synovial attachment, just proximal to the articular surface, and inserts on the base of the proximal phalanx. Deterioration of the plantar plate often leads to instability of the second MTP joint.
• As the principle stabilizer of the MTP joint, the integrity of the plantar plate is essential to stabilize the proximal phalanx of the lesser toes, and its attrition often results in metatarsalgia, plantar swelling, hammertoe deformity, and lesser toe subluxation. Surgical repairs of plantar plate ruptures have evolved with increased appreciation of the anatomy. Primary repairs involve direct visualization of the plantar plate injury and may involve an incision through the plantar of the foot which may lead to complications during healing. Other procedures that address MTP instability include the use of anchors, extensor tendon lengthening, flexor tendon transfers, metatarsal osteotomies and total joint implants, among others.
SUMMARY OF THE INVENTION
• The invention provides surgical repair systems and techniques for complete plantar plate repairs. The surgical repair systems and methods of the present invention reconstruct—through a dorsal incision—the plantar plate that leads to the instability of the second MTP joint, restoring the normal alignment of the joint, and minimizing healing complications.
• The surgical repair system of the present invention 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. Additional instruments may include drill bits and k-wires as are known for performing surgery. These specialized instruments (i) access an open surgical space and move the “capital fragment” in a controlled/precise manner; (ii) reach into the surgical space and pass suture either by using the Mini Scorpion DX or Micro Suture Lassos; (iii) pull suture through the bone tunnels enabling reattachment of the plantar plate (ligament) to the bone; and (iv) confer a successfully tensioned plantar plate.
• The plantar plate repair method of the present invention comprises inter alia the steps of: (i) intraoperatively demonstrating a plantar plate tear (second metatarsal head is inferior) in the second MTP joint by distraction; (ii) transfixing the plate with a suture passer (mini Scorpion or microsuture lassos) (just proximal to the tear) and pulling a suture through the plantar plate; (iii) positioning sutures (preferably two sutures with four tails) at the distal aspect of the plantar plate (not yet passed through the phalanx); (iv) passing the suture through the dorsal to plantar drill hole; (v) fixating a metatarsal shortening osteotomy (Weil osteotomy) before tying the sutures; and (vi) tying the sutures with the toe in plantar flexion. At least one of the above-noted steps is conducted with at least one of the instruments of the repair system of the present invention.
• These and other features and advantages of the invention will be more apparent from the following detailed description that is provided in connection with the accompanying drawings and illustrated exemplary embodiments of the invention.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1(a) illustrates a partial cross-sectional view of a Mini Scorpion DX of the present invention employed for plantar plate repair.
• FIG. 1(b) is a top view of the Mini Scorpion DX ofFIG. 1(a).
• FIG. 1(c) is a perspective view of the Mini Scorpion DX ofFIG. 1(a).
• FIG. 2(a) illustrates a perspective view of a Mini Scorpion DX needle with molded handle employed with the Mini Scorpion DX ofFIG. 1(c).
• FIG. 2(b) is a top view of the Mini Scorpion DX needle ofFIG. 2(a).
• FIG. 2(c) is a partial cross-sectional view of the Mini Scorpion DX needle ofFIG. 2(a).
• FIG. 2(d) is a left side view of the Mini Scorpion DX needle ofFIG. 2(c).
• FIG. 3(a) illustrates a top view of a Micro Suture Lasso according to an exemplary embodiment of the present invention (plantar plate pig-tails), and employed for plantar plate repair.
• FIG. 3(b) is a lateral view of the Micro Suture Lasso ofFIG. 3(a).
• FIG. 3(c) is an enlarged view of detail A ofFIG. 3(a).
• FIG. 3(d) is a right side view of detail A ofFIG. 3(c).
• FIG. 4(a) illustrates a top view of a Micro Suture Lasso according to another exemplary embodiment of the present invention (micro suture lasso needle), and employed for plantar plate repair.
• FIG. 4(b) is a cross-sectional view of the Micro Suture Lasso ofFIG. 4(a).
• FIG. 4(c) is an enlarged view of detail G ofFIG. 4(b).
• FIG. 4(d) is an enlarged view of detail H ofFIG. 4(b).
• FIG. 4(e) is an enlarged view of detail J ofFIG. 4(a).
• FIG. 5(a) illustrates a top view of a Micro Suture Lasso according to another exemplary embodiment of the present invention, and employed for plantar plate repair.
• FIG. 5(b) is a lateral view of the Micro Suture Lasso ofFIG. 5(a).
• FIG. 5(c) illustrates a top view of a Micro Suture Lasso according to another exemplary embodiment of the present invention, and employed for plantar plate repair.
• FIG. 5(d) is a lateral view of the Micro Suture Lasso ofFIG. 5(c).
• FIG. 6(a) illustrates a top view of a Micro Suture Lasso according to another exemplary embodiment of the present invention, and employed for plantar plate repair.
• FIG. 6(b) is a cross-sectional view of the Micro Suture Lasso ofFIG. 6(a).
• FIG. 6(c) is a perspective view of the Micro Suture Lasso ofFIG. 6(a).
• FIG. 6(d) is an enlarged view of detail B ofFIG. 6(c).
• FIG. 6(e) is an enlarged view of detail A ofFIG. 6(b).
• FIG. 7(a) illustrates a top view of a Micro Suture Lasso according to another exemplary embodiment of the present invention, and employed for plantar plate repair.
• FIG. 7(b) is a lateral view of the Micro Suture Lasso ofFIG. 7(a).
• FIG. 7(c) is an enlarged view of the most distal end of the Micro Suture Lasso ofFIG. 7(a).
• FIG. 8(a) illustrates a lateral view of a Micro Suture Lasso according to another exemplary embodiment of the present invention, and employed for plantar plate repair.
• FIG. 8(b) is an enlarged view of the most distal end of the Micro Suture Lasso ofFIG. 8(a).
• FIG. 9(a) illustrates a side view of a Suture Retriever of the present invention employed for plantar plate repair and according to an embodiment of the present invention (with a stopper).
• FIG. 9(b) illustrates a side view of a Suture Retriever of the present invention employed for plantar plate repair and according to another embodiment of the present invention (without a stopper).
• FIG. 10(a) illustrates a frontal view of a Suture Retriever funnel (sleeve) employed with the Suture Retrieval ofFIGS. 9(a) and9(b).
• FIG. 10(b) is a cross-sectional view of the Suture Retriever funnel (sleeve) ofFIG. 10(a), taken along line A-A ofFIG. 10(a).
• FIG. 11(a) illustrates a schematic top view of a plantar plate Pusher (which may be reusable or disposable) of the present invention employed for plantar plate repair.
• FIG. 11(b) is a side view of the plantar plate Pusher ofFIG. 11(a).
• FIG. 11(c) is an enlarged view of the distal end of the plantar plate Pusher ofFIG. 11(a).
• FIG. 11(d) is a left side view of the plantar plate Pusher ofFIG. 11(c).
• FIG. 11(e) is a cross-sectional view of the plantar plate Pusher ofFIG. 11(d), taken along line A-A ofFIG. 11(d).
• FIG. 12(a) illustrates a schematic top view of a plantar plate Measuring Guide (which may be disposable) of the present invention employed for plantar plate repair.
• FIG. 12(b) is a side view of the plantar plate Measuring Guide ofFIG. 12(a).
• FIG. 13 illustrates a plantar plate Distractor of the present invention employed for plantar plate repair.
• FIGS. 14(a)-(d) illustrate subsequent steps of a method of plantar plate repair according to an embodiment of the present invention.
• FIGS. 15(a)-(f) illustrate another series of subsequent steps of a method of complete plantar plate repair according to another embodiment of the present invention.
• FIGS. 16(a)-(c) illustrate a series of steps of a plantar plate repair with a suture retriever without a funnel.
• FIGS. 17(a)-(c) illustrate a series of steps of a plantar plate repair with a suture retriever with a funnel.
• FIGS. 18-42 illustrate another series of steps of a method of complete plantar plate repair according to another embodiment of the present invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• The present invention provides systems and methods for plantar plate repair. The systems of the present invention include surgical instruments that confer enhanced repair (a tensioned plantar plate), while decreasing the chance of wound complications and plantar tissue trauma.
• An exemplary method of plantar plate repair employing a dorsal approach and combining a Weil osteotomy in accordance with the present invention comprises inter alia the steps of: Weil osteotomy is performed allowing the capital fragment to be recessed under the metatarsal; digital distraction is obtained using a distraction clamp over K-wires; the plantar plate is assessed and repaired using suture (with a novel suture passing hand instrument known as the Mini Scorpion DX—this device allows the surgeon to pass suture through the plantar plate); the plantar plate is repaired back to the proximal phalanx. According to this method (the Complete Plantar Plate Repair or the CPR method), surgeons now have the option to repair the primary pathology, the plantar plate itself, using a dorsal approach.
• Referring now to the drawings, where like elements are designated by like reference numerals,FIGS. 1-13 illustrate surgical instruments of the system of the present invention employed during a method of plantar plate repair.FIGS. 14-42 illustrate exemplary steps of methods ofplantar plate repair100 with the instruments ofFIGS. 1-13.
• FIGS. 1(a)-(c) illustrate various views of a MiniScorpion™ DX10 employed for a plantar plate repair according to an embodiment of the present invention. The MiniScorpion™ DX10 includes the following components/features: Mini Scorpion™ DX tip-tube1; Mini Scorpion™ DX actuator2;Scorpion link3; cutter tip4 (for example, a 4.2 mm standard cutter tip4); Mini Scorpion™ DX jaw5; Scorpion Fastpass trap door6; Scorpion Fastpasstrap door spring7; tip pin8 (for example, a 4.5 mm tip pin8);Scorpion thumb9;Scorpion palm10a;Scorpion stop arm11;Scorpion spring rod12;Scorpion handle spring13; reverse punch setscrew14;Scorpion finger15;Scorpion finger spring16; and Scorpion handlepin17.
• FIGS. 2(a)-(d) illustrate various views of a Mini Scorpion™ DX needle18 with an exemplary nitinol weldedtube18aand an exemplary moldedhandle18b(with ahandle notch18d) employed with the MiniScorpion™ DX10 ofFIGS. 1(a)-(c). Mini Scorpion™ DX needle18 is also provided with asuture notch18cat its most distal end.FIG. 2(a) shows theinstrument18 with thesuture notch18con right and thehandle notch18don the bottom. The MiniScorpion™ DX10 andneedle18 function well to pass a mattress stitch in the plantar plate, particularly in tight spaces.
• FIGS. 3(a)-(d) illustrate various views ofMicro Suture Lasso20 according to an exemplary embodiment of the present invention.FIGS. 4(a)-(e) illustrate various views ofMicro Suture Lasso22 according to another exemplary embodiment of the present invention.FIGS. 5(a)-(d) illustrate various views ofMicro Suture Lasso20a,20a′ according to yet other exemplary embodiments of the present invention (with different curvatures of the distal shaft of the instrument).FIGS. 6(a)-(e) illustrate various views ofMicro Suture Lasso20baccording to another exemplary embodiment of the present invention.FIGS. 7(a)-(c) illustrate various views ofMicro Suture Lasso20caccording to another exemplary embodiment of the present invention.FIGS. 8(a)-(b) illustrate various views ofMicro Suture Lasso20daccording to another exemplary embodiment ofLassos20a,20b,20c,20d,22 are particularly useful in small-size patients and pass a mattress stitch more proximally in the plantar plate.
• FIG. 9(a) illustrates a side view of aSuture Retriever30 provided with loop31 (a Nitinol loop31) and withstopper33.FIG. 9(b) illustrates a side view of aSuture Retriever30aprovided withoutstopper33. Both instruments may be employed for the plantar plate repair of the present invention and are provided withNitinol loop31 to pull a flexible strand (for example, suture) through the bone tunnels.
• FIGS. 10(a)-(b) illustrate an exemplary funnel35 (sleeve35) employed with the Suture Retriever ofFIGS. 9(a)-(b). TheSuture Retriever30,30aand funnel35pass suture71,72 through thephalanx80. Steps for a plantar plate repair with a suture retriever without a funnel35 (sleeve35) are illustrated inFIGS. 16(a)-(c) which show how theNitinol loop31 cannot be pushed and how the loop doubles back and drags behind (on the plantar side, the wire must extend the length of the loop in order for it to be released). Steps for a plantar plate repair with a suture retriever with a funnel35 (sleeve35) of the present invention are illustrated inFIGS. 17(a)-(c) which show afunnel35 of only about 1.5 inches long (to fit in a 1.1 or 1.6 mm K-wire hole). The smooth and flexibleplastic sleeve35 can be preloaded on the retriever or placed free-hand. Thesleeve35 can slide up the retriever (in situ).
• FIGS. 11(a)-(e) illustrate various views of aplantar plate Pusher40 which may be reusable or disposable and which may be employed to slide the capital fragment back.
• FIGS. 12(a)-(b) illustrate a plantarplate Measuring Guide50 which is preferably disposable.
• FIG. 13 illustrates a plantar plate Distractor60 (small joint Distractor60).
• The repair system of the present invention includes at least one of the following instruments:
• a metatarsal head pusher (such as plantar plate pusher40) employed in open surgical space, to move the “capital fragment” in a controlled manner; this pusher has a specifically-designed head to prevent damage to the articular cartilage while pushing the fragment;
  a measuring guide (such as plantar plate measuring guide50);
  a plantar plate distractor (such as plantar plate distractor60)—designed to work with k-wires to distract the joint;
  k-wires to work with the plantar plate distractor;
  flexible strands such as sutures—for example,FiberWire® suture71,72;
  a suture passer such as a MiniScorpion™ DX10 and accompanyingneedle18, or a set of MicroSuture Lassos™20,20a,20a′,20b,20c,20d,22;
  a suture retriever instrument (such assuture retriever30,30a)—Nitinol loop31 to pull thesuture71,72 through the bone tunnels; and
  a suture retriever sleeve or funnel (such as suture retrieval funnel35)—if used, this instrument ensures that thenitinol loop31 on thesuture retriever30,30adoes not loop back.
• FIGS. 14(a)-(d) illustrate subsequent steps of a method of plantar plate repair according to an embodiment of the present invention, illustrating suture passer10 (Mini Scorpion™ DX10) and accompanyingneedle18 andplantar plate distractor60.
• FIGS. 15(a)-(f) illustrate another series of subsequent steps of a method of complete plantar plate repair according to an embodiment of the present invention:
• FIG. 15(a): intraoperative demonstration of distraction of the second MTP joint99 with a plantar plate tear77 (second metatarsal head90 is inferior);
  FIG. 15(b): a suture passer transfixing the plantar plate70 (just proximal to the tear77) and helping to pull theflexible strand71,72 (for example, suture) through theplantar plate70;
  FIG. 15(c): twoflexible strands71,72 (for example, twosutures71,72) positioned at the distal aspect of the plantar plate (not yet passed through the phalanx);
  FIG. 15(d): passing theflexible strands71,72 (sutures71,72) through the dorsal to plantar drill hole;
  FIG. 15(e): fixation of metatarsal shortening (Weil) osteotomy before tying theflexible strands71,72 (sutures71,72); and
  FIG. 15(f): tying theflexible strands71,72 (sutures71,72) with the toe in plantar flexion to formknots71a,72aoffinal repair100a.
• An exemplary surgical technique for a plantar plate repair with the instrument system of the present invention follows the exemplary steps below:
• 1. A dorsal longitudinal incision is centered over the second web space. A longitudinal capsulotomy is performed just inferior to the tendons of the extensor digitorum longus and brevis to expose the affected second MTP joint99.
• 2. A partial collateral ligament release off of theproximal phalanx80 of the MTP joint99 improves visualization.
• 3. A metatarsal shortening osteotomy (Weil osteotomy) is performed using a sagittal saw. The saw cut is made parallel to the plantar aspect of the foot, starting at apoint 2 to 3 mm below the top of the metatarsal articular surface. The capital fragment is provisionally pushed proximally about 10 mm and fixed with a temporary vertical Kirschner wire (k-wire), to hold it in a retracted position.
• 4. A second vertical Kirschner wire is then placed in the base of the proximal phalanx. A specialplantar plate distractor60 is placed over the vertical wires and spread to expose theplantar plate70.
• 5. Theplantar plate tear77 is evaluated and graded. Longitudinal tears in the plate (grade 3) are repaired with a side-to-side interrupted suture (for example, a 0-FiberWire®). Distal transverse tears (grades 1 and 2) are repaired by placing the same suture in the distal plantar plate. The distal plantar edge of the proximal phalanx is roughened with a burr or curette to prepare a surface for reimplantation of the plantar plate. The distal plantar plate is transfixed just proximal to the transverse tear using a small curved needle or a special curved Micro Suture Lasso such as, for example,Micro Suture Lasso20 ofFIGS. 3(a)-(d), or a suture passing instrument such as, for example,Mini Scorpion DX10 ofFIGS. 1(a)-(c) to pass theflexible strand71,72 (suture71,72) within the restricted MTP joint surgical area of exposure.
• 6. Using a 1.6-mm drill or k-wire, two parallel drill holes are created medially and laterally on theproximal phalanx80, directed from the dorsal cortex of the proximal phalanx to the plantar rim of the proximal phalanx. This permits passing of a suture, plantar to dorsal, to fix theplantar plate70 to its insertion point at the plantar base of thephalanx80.
• 7. The metatarsal shortening (Weil) osteotomy is then reduced (to surgeon's desired position). It is fixed in optimal position with one or two small screws or k-wire.
• 8. The toe is held reduced on the metatarsal articular surface, in plantar flexion, and with tension on thesutures71,72 (having been pulled through the holes in the proximal phalanx80). They are tied over the dorsal phalangeal cortex, thus advancing the plantar plate onto the base of the proximal phalanx.
• 9. A lateral soft tissue reefing to repair the lateral collateral ligamentous release is performed with nonabsorbable sutures.
• 10. An interrupted wound closure is performed. The foot is placed in tape compression dressing with the digit held in 10° to 15° of plantar flexion.
• FIGS. 18-42 illustrate the steps of a plantar plate repair with the instruments of the present invention in accordance with another embodiment of the invention:
• FIGS. 18 and 19: Thetear77 is visualized; if more than 40% is torn, detach theplantar plate70 from the rim of the proximal phalanx80 (an elevator may be optionally used).
• FIGS. 20-23: A metatarsal shortening osteotomy is performed withosteotome75. Use themetatarsal pusher40 to push the plantar fragment between 8-10 mm away from the joint99 and provisionally fixate with 1.6 mm threaded or non-threaded k-wire76.
• FIGS. 24 and 25: Optionally, based on pre-operative measurements, a template can be used to cut the dorsal shelf of the metatarsal to a specific length using a bone cutter. This will allow better visualization and access to theplantar plate70.
• FIGS. 26-28: A uniqueplantar plate distractor60 with 1.6 or 2.0 mm threaded or non-threaded k-wires is then placed in thephalanx80 and themetatarsal90 and distracts the joint99.
• FIGS. 29 and 30: Create anoose71aat the end of the flexible strand71 (#0 FiberWire® suture71) and load it into theMini Scorpion DX10.
• FIGS. 31 and 32: Fire theneedle18 medial and lateral, creating aninverted mattress stitch78 in theplantar plate70. The step is repeated for twoindependent sutures71,72 in theplantar plate70.
• FIGS. 33-36: Remove thedistractor60 and use atowel clamp62 to plantar flex thephalanx80. Two crossing drill holes82 using a 1.6 mm k-wire82 are made in theproximal phalanx80. This allows passing asuture71,72 plantar to dorsal, to fix theplantar plate70 to its insertion point at the plantar base of thephalanx80. The k-wire exits the phalanx just below the cartilage (arrows A ofFIG. 35). This allows for easier suture passing.
• FIGS. 37-39: Pass thesutures71,72 using themicro suture lasso20. The suture passer must not flip back on itself when passing in the hole. A mosquito may be used to aid in the passing of thesutures71,72 into the suture passer.
• FIGS. 40 and 41: Weil osteotomy is then fixed in optimal position with one or two fixation devices92 (such as 2.0 mm Quickfix screws92 or any screw or pin). The toe is held in the optimal position and both sets of suture ends71,72 are tied over thephalanx80 formingknots71a,72a(FIG. 42).
• FIG. 42 shows thefinal repair100.
• Theflexible strands71,72 may be made of any known suture material, such as ultrahigh molecular weight polyethylene (UHMWPE) or the FiberWire® suture (disclosed in U.S. Pat. No. 6,716,234 which is hereby incorporated by reference in its entirety).
• While the present invention is described herein with reference to illustrative embodiments for particular applications, it should be understood that the invention is not limited thereto. Those having ordinary skill in the art and access to the teachings provided herein will recognize additional modifications, applications, embodiments and substitution of equivalents all fall within the scope of the invention. Accordingly, the invention is not to be considered as limited by the foregoing description.

Claims (15)

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 ofclaim 1, further comprising the step of reattaching the plantar plate to bone.

3. The method ofclaim 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 ofclaim 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 ofclaim 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 ofclaim 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 ofclaim 1, wherein the flexible strand is suture.

8. The method ofclaim 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 ofclaim 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 ofclaim 11, wherein the at least one flexible strand is suture.

13. The surgical kit ofclaim 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 ofclaim 14 further comprising an inverted mattress stitch on the plantar plate and at least one fixation device for Weil osteotomy on the metatarsal.

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