Microvasculature of the Plantar Plate Using Nano–Computed Tomography

Abstract

Background: Lesser toe plantar plate attenuation or disruption is being increasingly implicated in a variety of common clinical conditions. A multitude of surgical techniques and devices have been recently developed to facilitate surgical repair of the plantar plate. However, the microvascular anatomy, and therefore the healing potential in large part, has not been defined. We investigated the microvasculature of the plantar plate by employing a novel technique involving microvascular perfusion and nano–computed tomography (nano-CT) imaging. Methods: Twelve human adult cadaveric lower extremities were amputated distal to the knee. The anterior and posterior tibial arteries were perfused with a barium solution. The soft tissues of each foot were then counterstained with phosphomolybdic acid (PMA). The second through fourth toe metatarsophalangeal (MTP) joints of 12 feet were imaged with nano-CT at 14-micron resolution. Images were then reconstructed for analysis of the plantar plate microvasculature and calculation of the vascular density along the length of the plantar plate. Results: A microvascular network extends from the surrounding soft tissues at the attachments of the plantar plate on both the metatarsal and proximal phalanx. The midsubstance of the plantar plate appears to be relatively hypovascular. Analysis of the vascular density along the length of the plantar plate demonstrated a consistent trend with increased vascular density at approximately the proximal 29% and distal 22% of the plantar plate. Conclusion: There is a vascular network extending from the surrounding soft tissues into the proximal and distal attachments of the plantar plate. Clinical relevance: The hypovascular midportion of the plantar plate may play an important role in the underlying pathoanatomy and pathophysiology of this area. These findings may have significant clinical implications for the reparative potential of this region and the surgical procedures currently described to accomplish anatomic plantar plate repair.

Microvascular Tissue Engineering—A Review

“…The detailed geometry and functionality of the vascular tree can be assessed with various imaging techniques. The most commonly used techniques are magnetic resonance imaging (MRI) and nano-CT/micro-CT, complemented with an infusion of contrast agents or fluorescent lipids to evaluate the state of perfusability [ 1 , 3 , 150 ]. See Figure 11 for an illustration of micro-CT imaging.…”

Histological changes of the plantar plate in patients with metatarsalgia

“…Більшість авторів вважають, що дегенеративні зміни ПП капсули ПФС, які виникають під впливом тривалого циклічного перевантаження, є основною причиною больового синдрому та розвитку метатарзалгії, а аваскулярність центральної частини ПП сповільнює її регенерацію в разі хронічного перевантаження [4,5,10,11].…”

Presence of Neovascularization in Torn Plantar Plates of the Lesser Metatarsophalangeal Joints

“…7,40 Specifically, an underlying pathologic instability of the plantar plate and MTP joint collateral ligaments is seen in common clinical conditions including hammertoes and crossover toes. 16,19 These conditions represent a major source of pain and dysfunction and constitute some of the most common complaints presented to foot and ankle surgeons. 16,38 The anatomy and histochemistry of the plantar plate has been previously described, 12,18,22,25,45 drawing comparisons to the meniscus of the knee as both are fibrocartilaginous structures that sustain compressive and tensile loads.…”

“…3 A recent study has similarly demonstrated that the microvasculature of the normal plantar plate is densest at the proximal and distal attachments with a relatively hypovascular midsubstance. 19 As a tissue's potential for healing is directly linked to the availability of arterial blood supply, 4 meniscal repair is not attempted in the central zone where inflammatory and nutritional support are unavailable. 19 In contrast, there is a body of literature emphasizing the technical aspects of direct anatomic repairs of the plantar plate, yet it remains unknown whether the plantar plate has the biological capacity to heal these repairs.…”

“…19 As a tissue's potential for healing is directly linked to the availability of arterial blood supply, 4 meniscal repair is not attempted in the central zone where inflammatory and nutritional support are unavailable. 19 In contrast, there is a body of literature emphasizing the technical aspects of direct anatomic repairs of the plantar plate, yet it remains unknown whether the plantar plate has the biological capacity to heal these repairs. 19 Therefore, a better understanding of the plantar plate vasculature in response to injury may provide further insight into the potential for healing after anatomic plantar plate repair.…”