MRI in the evaluation of plantar plate disease: diagnostic value of the “stress test”

• Published in: Journal of orthopaedics and traumatology 2024-12, Vol.25 (1), p.70-12, Article 70
• Main Authors: Giuliani, Luca, Ottonello, Carlo, Giuliani, Alessandra, Bondì, Lucia, Ronconi, Paolo, Tempesta, Valerio, Pacini, Patrizia, Cantisani, Vito
• Format: Article
• Language: English
• Subjects: Adult; Aged; Asymptomatic; Bone marrow; Conservative Orthopedics; Diagnostic systems; Discordance; Dorsal subluxation of the metatarsophalangeal joint; Edema; Evaluation; Exercise Test - methods; Female; Foot Diseases - diagnosis; Foot Diseases - diagnostic imaging; Forefoot MRI; Humans; Joint diseases; Joints (anatomy); Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical imaging; Medical treatment; Medicine; Medicine & Public Health; Metatarsophalangeal Joint - diagnostic imaging; Middle Aged; Original; Original Article; Orthopedics; Patients; Plant diseases; Plantar plate; Plantar Plate - diagnostic imaging; Plantar Plate - injuries; Radiology; Rheumatology; Sensitivity analysis; Sports Medicine; Stress test; Surgical Orthopedics; Traumatic Surgery; Ultrasonic imaging; Ultrasound
• ISSN: 1590-9999; 1590-9921; 1590-9999
• DOI: 10.1186/s10195-024-00814-x

Introduction The plantar plate, also called the plantar ligament, is a fibrocartilaginous structure found in the metatarsophalangeal (MTP) and interphalangeal (IP) joints. Our study aimed to evaluate the role of magnetic resonance imaging (MRI) performed with the patient in the standard position or with joint hyperextension (the “stress test”, ST) in the study of plantar plate (PP) disease that involves metatarsophalangeal joints. Materials and methods All patients underwent forefoot MRI (Atroscan C, Esaote, Genoa, Italy), operating at 0.2 T. All patients first underwent a standard MRI examination (coronal T1 and T2 weighted image (WI) with fat suppression and axial and sagittal T2 WI); the examination was completed by performing a stress test (hyperextension of toes). The ST is an easy task to perform and is not time-consuming (requiring only one additional sagittal fast spin echo (FSE) T2-weighted MRI sequence; repetition time/ echo time (TR/TE): 3200/90 ms) for patients and operators. A 45°-dorsiflexion ST was performed for approximately 2.30 min, the time required to complete the sequence. No further diagnostic investigations were necessary; no patients underwent arthrography or arthro-MRI. The examinations were performed in a double-blind mode by two operators with proven experience in musculoskeletal radiology; no cases of intra-operator discordance were found. Results Twenty-five patients were recruited into our study over a 2-year period; 15 were positive for metatarsal pain and 10 were controls. Before treatment (surgery), all patients displaying symptoms underwent evaluation. As a result, the imaging features accurately represented the natural and actual conditions of the lesions. Among the symptomatic patients, 11 out of the 15 exhibited a PP tear or dysfunction in both the standard position and the ST. Additionally, two out of the 15 individuals displayed a tear in the ST alone, with no indication of it in the standard position. In contrast, two out of 15 patients showed no evidence of a PP tear in either the standard position or the ST. However, these two patients demonstrated dorsal subluxation during the ST, likely due to micro-instability resulting from PP failure. In the asymptomatic patients, nine out of the 10 individuals were found to be negative for PP dysfunction. Only one out of the 10 patients exhibited dorsal subluxation solely in the ST, indicative of plantar plate dysfunction, but no evidence of a tear in the PP. In the asymptoma