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Finney et al
both tails of the Mason-Allen exit centrally, which leads to
a higher force concentration in a small piece of tissue. In
addition, the extra needle passes required to perform the
Mason-Allen may weaken the construct through more tissue damage.
Limitations of this study include the generalizability of
results using a cadaveric model. The plantar plate tissue
quality in a cadaveric model may not directly mimic that of
an in vivo environment, as clinically torn plantar plates may
be thinner and degenerated. However, a biomechanical
strength model of this type cannot be tested in vivo. This
experiment was limited to only 3 suture configurations. The
suture configurations were chosen based on currently
described techniques (luggage-tag and horizontal mattress
stitches) and the strongest configuration demonstrated in
rotator cuff testing (modified Mason-Allen); however, a
stronger configuration might exist that was not included in
testing. This model also only allowed for measurement of
the suture grasp of the plantar plate and did not include the
suture-bone interface of the proximal phalanx. However,
none of the constructs failed at the knot, and the suture-bone
interface was assumed to be stronger than the suture-ligament interface.
In addition, the current model did not eliminate the
ligament-bone interface of the metatarsal, so the sutureligament interface was not isolated for measurement of
displacement or stiffness. After cyclic loading, there was
no grossly visible gapping at the suture-ligament interface in any specimen. However, the number of cycles and
peak force during cycling may have been too low to create visible displacement. The peak force for cyclic loading was chosen as half of the lowest load-to-failure force
during pilot testing, which occurred in luggage-tag suture
configurations. Interestingly, cyclic loading prior to loadto-failure testing appeared to change the mechanism of
failure for luggage tag configurations from suture breaking at the loop of the luggage tag, which occurred in 2 of
3 specimens during pilot testing, to cutout at the sutureligament interface.
In conclusion, this study is the first to provide a biomechanical analysis of suture configurations used in plantar
plate repairs. Suture configurations were tested in human
cadaveric plantar plate specimens, and each configuration
was tested on an equal number of second, third, and fourth
toe MTP joint plantar plates. The results of this study suggest that the horizontal mattress stitch may be the biomechanically superior configuration in plantar plate repairs.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
ICMJE forms for all authors are available online.

Funding
The authors received no financial support for the research, authorship, and/or publication of this article.

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Table of Contents for the Digital Edition of Foot & Ankle International - July 2018