Plantar plate repair for lesser metatarsophalangeal joint instability: a systematic review of outcomes

Introduction: Lesser metatarsophalangeal joint instability is a frequent cause of metatarsalgia and digital deformity produced by degeneration or rupture of the plantar plate. Direct surgical repair of the plantar plate has spread rapidly, yet the outcomes reported across techniques remain scattered. Methods: Systematic review reported according to PRISMA 2020. Web of Science Scopus, PubMed, OpenAlex, Embase, Semantic Scholar were searched from 2015 to 2024 for clinical studies of plantar plate repair for lesser metatarsophalangeal joint instability. Results: Twenty studies (1,190 reported repairs or affected rays) were included, mostly retrospective case series. Maintenance of reduction or clinical stability ranged from 80% to 95% across series, and recurrent instability from 7.6% to 22%. Pain and function improved in every study that measured them, with AOFAS gains of 28 to 43 points and visual analogue scores of 1.5/10 or less after surgery. The largest series reported 15% complications, mostly superficial infection (6.8%) and painful scar (8.3%), with 1.4% reoperation. Conclusions: Plantar plate repair restores lesser metatarsophalangeal stability and improves pain and function with modest recurrence and complication rates, although the evidence is limited by predominantly retrospective single-surgeon designs.