Second and Third Metatarsophalangeal Plantar…

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Second and Third

Metatarsophalangeal Plantar Plate
Tears: Diagnostic Performance of
Direct and Indirect MRI Features
Using Surgical Findings as the
Reference Standard

André Fukunishi Yamada1,2, Michel D.

Crema2,3,4, Caio Nery5, Daniel Baumfeld6, Tania
Szejnfeld Mann5, Abdalla Y. Skaf2 and Artur da
Rocha Correa Fernandes1
Address correspondence to A. F. Yamada
(andrefyamada@gmail.com).
1Department of Diagnostic Imaging, Federal University of São
Paulo, Rua Napoleão de Barros, 800, São Paulo, SP 04024-
002, Brazil.
2Department of Radiology, Hospital do Coração and
Teleimagem, São Paulo, Brazil.
3Department of Radiology, Quantitative Imaging Center,
Boston University School of Medicine, Boston, MA.
4Department of Radiology, Hôpital Saint-Antoine, Paris VI
[ J
University, Paris, France. R S ]
5Department of Orthopedics, Federal University of São Paulo,
São Paulo, Brazil.
6Department of Orthopedics, Federal University of Minas
Gerais, São Paulo, Brazil.

American Journal of Roentgenology

Vol. 209: , Issue. 2, : Pages. W100-W108

(Issue publication date: August 2017)

https://doi.org/10.2214/AJR.16.17276

OBJECTIVE. The objective of our study was to

assess the diagnostic performance and
associations of the direct and indirect MRI
features of the metatarsophalangeal (MTP) joint
that are thought to be related to tears of the
plantar plate (PP) using surgical findings as the
reference standard.

MATERIALS AND METHODS. We

retrospectively included 23 patients with
symptomatic instability of lesser MTP joints
who had undergone preoperative 1.5-T MRI and
surgical assessment. The MRI examinations
were independently assessed by two
musculoskeletal radiologists. Using the surgical
data as the reference standard, we calculated the
sensitivity, specificity, and accuracy of each MRI
feature in the detection of PP tears. Multivariate
logistic regression analysis was performed to
identify which MRI features were independently
associated with PP tears. Interobserver reliability
was assessed using kappa statistics.
RESULTS. Forty-five lesser MTP joints were
included. The presence of pericapsular fibrosis
was highly sensitive (91.2%), specific (90.9%),
and accurate (91.1%) for the diagnosis of PP
tears. With a cutoff value of 0.275 cm, the PP–
proximal phalanx distance had a sensitivity of
64.7%, specificity of 90.9%, and accuracy of
71.1% in diagnosing PP tears.

CONCLUSION. In patients with clinical features

indicating lesser MTP joint instability, some
direct and indirect MRI features exhibited good
to excellent diagnostic performance in detecting
the presence of PP tears.

Keywords: arthroscopy, imaging,

metatarsophalangeal joint, MRI, plantar plate

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