Original research
Second metatarsophalangeal joint arthrography: A cadaveric correlation study

https://doi.org/10.1053/j.jfas.2004.05.009Get rights and content

Abstract

Arthrography of the second metatarsophalangeal joint is an important diagnostic tool to evaluate the integrity of the plantar plate and to aid in the decision process for surgical intervention. A variety of filling patterns have been identified with lesser metatarsophalangeal joint arthrography and their significance with soft-tissue pathology remains to be completely understood. The purpose of this cadaveric study was to evaluate dye patterns in a series of arthrograms of the second metatarsophalangeal joint and to correlate them with identifiable anatomic lesions or structural variants. Thirty-nine cadaveric specimens (including 28 matched pairs) underwent second metatarsophalangeal joint arthrography with a colored radiopaque dye. Arthrographic findings were observed and recorded. Specimens exhibiting dye extravasation outside of the capsular constraints of the joint were dissected to discover any soft-tissue abnormalities. Twenty-one percent of specimens exhibited abnormal extravasation of dye outside of the joint capsule. A plantar plate tear was identified in 2 of these specimens. Filling of the first intermetatarsophalangeal bursa occurred in 6 specimens. However, because this finding was identified in 2 matched pairs, an anatomic variance is suggested rather than a pathologic entity. This cadaveric study shows that anatomic variances exist concerning the second metatarsophalangeal capsule and that arthrography should be correlated with the clinical scenario.

Section snippets

Anatomy

The anatomy of the second MTPJ has been extensively studied in cadavers 17, 18, 19. The capsule of the second MTPJ is formed by the confluence of several structures. It is mainly composed of ligamentous structures and receives additional support from the tendons spanning the joint. The plantar aspect consists of thickened fibrocartilaginous tissue termed the plantar plate 18, 19.

Dorsally, the extensor expansion of the extensor digitorum longus and brevis tendons forms the roof of the joint. A

Materials and methods

Thirty-nine fresh-frozen cadaveric forefoot specimens were used in this study. The average age was 73 years (range, 54 to 92 years). Twenty-eight specimens were matched pairs; of the remaining 11 specimens, there were 7 left feet and 4 right feet. All specimens were thawed at room temperature in damp towels. The specimens included in this study had not had previous surgical intervention involving the forefoot and had no obvious gross deformities. Radiographic imaging was performed to rule out

Results

Arthrograms exhibiting dye extravasation outside of the capsular confines of the second MTPJ occurred in 18 specimens. The remaining 21 specimens showed 3 distinct areas of dye collection: the dorsal joint line and the proximal plantar medial and lateral synovial recesses. Because a dorsal approach was used to enter the joint, the dorsal distribution of dye was visualized first. Next, outlining of the joint line occurred followed by filling of the proximal plantar medial and lateral recesses

Discussion

The use of arthrography to aid in the diagnosis of second MTPJ pathology was popularized by Karpman and MacCollum (6) in 1988 and by Yao et al (4) in 1994. As arthrography becomes more widely used, the significance of various arthrographic patterns surrounding the second MTPJ will be further established. Karpman and MacCollum (6) defined an abnormal arthrogram for a plantar plate tear as one in which dye extravasates into the flexor sheath. Powless and Elze (3) believe this may occur in a

Conclusion

Second MTPJ arthrography is a valuable diagnostic tool used to identify intraarticular pathology and to evaluate joint capsule integrity; however, the arthrographic variances are still being established. This study evaluated arthrographic patterns of the second MTPJ in the cadaveric model. Results showed an abnormal arthrogram in 21% of specimens. A plantar plate tear was identified in 2 specimens with abnormal arthrograms. This study shows that anatomic variances exist concerning the second

Acknowledgements

The authors thank Dean Clement, DPM, for assisting with the cadaveric testing.

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    Copyright © 2004 American College of Foot and Ankle Surgeons. Published by Elsevier Ltd. on behalf of the American College of Foot and Ankle Surgeons All rights reserved.