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Masaragian HJ, Rega L, Ameriso N, Perin F, Fabrego C, Veizaga J. The Potential of Endoscopic Spring Ligament Repair in Flatfoot Reconstruction. Foot Ankle Int 2023; 44:200-209. [PMID: 36825594 DOI: 10.1177/10711007231152874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND Spring ligament fulfills 2 main important functions: one, supporting the head of the talus and stabilizing the talonavicular joint, and the other, maintaining the longitudinal arch by acting as a static support. In this preliminary report, we describe an endoscopic repair for spring ligament injuries with modified portals. METHODS We performed a retrospective case series study from February 2019 to January 2022. Posterior tibial tendon and/or associated bone deformities were assessed at the same surgical procedure. All patients were ≥18 years old and they had more than 6 months of follow-up. The procedure was performed in 11 patients. Mean age was 46 years (range 18-63). Ten had concomitant bony realignment surgery, and 8 had posterior tibial tendon surgery. RESULTS In all patients, endoscopic spring ligament repair could be technically done. The modified portals were used in all procedures as described in the surgical technique. Three patients had a superficial lesion, 1 had a rupture <5 mm, 7 had a rupture >5 mm but not a complete rupture through the entire spring ligament. Most of the patients had good clinical results from the surgery that included endoscopic spring ligament debridement and/or repair at 2 years follow up. CONCLUSION In this small series we found that endoscopy may be an effective technique to diagnose and treat incomplete spring ligament injuries. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
| | - Leonel Rega
- Foot and ankle Surgeon, Cirugiadelpie.net, Buenos Aires, Argentina
| | - Nicolas Ameriso
- Foot and ankle Surgeon, Cirugiadelpie.net, Buenos Aires, Argentina
| | - Fernando Perin
- Foot and ankle Surgeon, Cirugiadelpie.net, Buenos Aires, Argentina
| | - Cesar Fabrego
- Foot and ankle Surgeon, Cirugiadelpie.net, Buenos Aires, Argentina
| | - Johann Veizaga
- Foot and ankle Surgeon, Cirugiadelpie.net, Buenos Aires, Argentina
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Abstract
A thorough knowledge of the anatomy of the deltoid and spring ligament complex is important for treatment of deformities that impact the foot and ankle. Both ligaments are interconnected, and the study of their anatomic characteristics is better performed together than in isolation. The deltoid ligament is a group of ligaments that derives its origin from the medial malleolus, and the spring ligament complex consist of a group of ligaments that connects the navicular and the sustentaculum tali of the calcaneus. They both play an important role in stabilization of the medial ankle and medial column of the foot.
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Affiliation(s)
- Jarrett D Cain
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Physicians, Pittsburgh, PA, USA
| | - Miki Dalmau-Pastor
- Human Anatomy Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; MIFAS By GRECMIP (Minimally Invasive Foot and Ankle Society), Merignac, France.
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Heyes G, Swanton E, Vosoughi AR, Mason LW, Molloy AP. Comparative Study of Spring Ligament Reconstructions Using Either Hamstring Allograft or Synthetic Ligament Augmentation. Foot Ankle Int 2020; 41:803-810. [PMID: 32356464 DOI: 10.1177/1071100720917375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Idiopathic flatfeet are usually caused by attenuation of the medial soft tissues rather than a lateral osseous deficiency. Debate continues on whether spring ligament attenuation or posterior tibial tendon (PTT) dysfunction is the initial driver for the deformity. Our comparative prospective study aimed to quantify the radiological and clinical outcomes of 2 techniques for spring ligament reconstruction using a hamstring graft or a synthetic ligament. METHODS Seventeen spring ligament reconstructions (SLRs) were performed in 17 patients using synthetic ligament augmentation and 16 SLRs were performed using hamstring allograft in 13 patients. Additional procedures such as gastrocnemius recession, PTT advancement, flexor digitorum longus transfer, and calcaneal osteotomy were performed as required. A minimum of 12 months of follow-up was available for all cases. Radiographic analysis was performed with standardized parameters. RESULTS Following SLR with synthetic ligament augmentation, all radiological parameters significantly improved (P < .05). Hamstring allograft SLR also demonstrated significantly improved radiographic parameters in all but Meary's line at final follow-up. At 12 months, patient outcome scores were significantly better in the synthetic ligament group. CONCLUSION Reconstruction of the spring ligament using either hamstring allograft or synthetic ligament augmentation provided significant improvements in radiological alignment; however, superior patient-reported outcomes were found in the synthetic ligament augmentation group. LEVELS OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Gavin Heyes
- Trauma and Orthopaedic Department, University Hospital Aintree, Lower Lane, Liverpool, UK
| | - Eric Swanton
- Trauma and Orthopaedic Department, University Hospital Aintree, Lower Lane, Liverpool, UK
| | - Amir Reza Vosoughi
- Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, Chamran Hospital, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Lyndon W Mason
- Trauma and Orthopaedic Department, University Hospital Aintree, Lower Lane, Liverpool, UK
| | - Andrew P Molloy
- Trauma and Orthopaedic Department, University Hospital Aintree, Lower Lane, Liverpool, UK
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Intra and Inter-rater Reliability between Ultrasound Imaging and Caliper Measures to determine Spring Ligament Dimensions in Cadavers. Sci Rep 2019; 9:14808. [PMID: 31616040 PMCID: PMC6794374 DOI: 10.1038/s41598-019-51384-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/30/2019] [Indexed: 12/14/2022] Open
Abstract
The purpose was to evaluate intra and inter-rater reliability, repeatability and absolute accuracy between ultrasound imaging (US) and caliper measures to determine Spring ligament (SL) dimensions in cadavers. SLs were identified from 62 human feet from formaldehyde-embalmed cadavers. Intra and inter-observer reliability, repeatability and absolute accuracy of SL width, thickness and length between US and caliper measurements were determined at intra and inter-session by intraclass correlation coefficients, Pearson´s correlation coefficients, Student t tests, standard errors of measurement, minimum detectable changes, values of normality, 95% limits of agreement, and Bland-Altman plots. Excellent inter-session and inter-rater reliability, adequate absolute accuracy, almost perfect agreement and strong correlations were shown for caliper, US and their comparison for all SL dimensions. US measurements presented higher absolute accuracy than caliper measures for SL length and thickness dimensions, while caliper displayed greater absolute accuracy for SL width dimensions. Good repeatability (P > 0.05) was shown for all SL dimensions by US, caliper and their comparison, except for SL width dimension measured with US (P = 0.019). Both US and caliper could be recommended for all SL dimensions evaluation due to their excellent reliability and absolute accuracy in cadavers, although width dimensions should be considered with caution due to US repeatability differences.
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Xu C, Li MQ, Wang C, Liu H. Nonanatomic versus anatomic techniques in spring ligament reconstruction: biomechanical assessment via a finite element model. J Orthop Surg Res 2019; 14:114. [PMID: 31036018 PMCID: PMC6489249 DOI: 10.1186/s13018-019-1154-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/12/2019] [Indexed: 11/12/2022] Open
Abstract
Background Several approaches to spring ligament reconstruction have been reported. However, a comparative study of nonanatomic and anatomic techniques with respect to biomechanical responses, such as kinematics and contact characteristics, has not been previously performed via a finite element analysis. The purpose of this study was to evaluate the biomechanical results of such spring ligament reconstructions via a finite element analysis. Methods A three-dimensional finite element model of the foot was developed and validated, and four reconstruction methods were simulated. The talonavicular dorsiflexion and abduction, hindfoot valgus, and contact characteristics in the Chopart joints were quantified in each model. Results Nonanatomic reconstructions corrected the talonavicular and hindfoot deformities to a greater extent than the anatomic reconstructions. The anatomic techniques also corrected the abduction and dorsiflexion deformities, although they presented insufficient power to correct for hindfoot valgus. None of the procedures restored the contact characteristics of the talonavicular and calcaneocuboid joints to those of a normal condition. Conclusion Nonanatomic reconstruction of the spring ligament complex provided the greatest correction for midfoot and hindfoot misalignments in flatfoot. Severe deformities with large amounts of midfoot pronation and hindfoot valgus may be better treated with nonanatomic reconstruction methods. The spring ligament reconstruction method may mitigate the need for nonanatomic bony procedures associated with complications and allows for the preservation of the triple joint complex.
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Affiliation(s)
- Can Xu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Ming Qing Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Chenggong Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Hua Liu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, China.
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Abstract
The spring ligament complex is an important static restraint of the medial longitudinal arch of the foot and its failure has been associated with progressive flatfoot deformity. Reconstruction of the spring ligament complex is most appropriate in stage II posterior tibial tendon dysfunction, before severe peritalar subluxation and rigid deformity develops. Although an understanding of the spring ligament complex and its contribution to medial arch stability has grown, there is no unanimously accepted surgical technique that has consistently demonstrated satisfactory outcomes. This article reviews the pathoanatomy of the spring ligament complex and the role of spring ligament reconstruction in acquired flatfoot deformity, and highlights current research.
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Affiliation(s)
- Brian Steginsky
- Illinois Bone and Joint Institute, 720 Florsheim Drive, Libertyville, IL 60048, USA
| | - Anand Vora
- Illinois Bone and Joint Institute, 720 Florsheim Drive, Libertyville, IL 60048, USA.
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Chhabra A, Soldatos T, Chalian M, Faridian-Aragh N, Fritz J, Fayad LM, Carrino JA, Schon L. 3-Tesla magnetic resonance imaging evaluation of posterior tibial tendon dysfunction with relevance to clinical staging. J Foot Ankle Surg 2011; 50:320-8. [PMID: 21459628 DOI: 10.1053/j.jfas.2011.02.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Indexed: 02/03/2023]
Abstract
The posterior tibial tendon (PTT) is the most important dynamic stabilizer of the medial ankle and longitudinal arch of the foot. PTT dysfunction is a degenerative disorder of the tendon, which secondarily involves multiple ligaments, joint capsules, fascia, articulations, and bony structures of the ankle, hindfoot, midfoot, and forefoot. When the tendon progressively attenuates, the patient develops a painful, progressive collapsed flatfoot or pes planovalgus deformity. This comprehensive review illustrates the 3-Tesla magnetic resonance imaging (3T MRI) features of PTT dysfunction. In addition, the reader will gain knowledge of the expected pathologic findings on MRI, as they are related to clinical staging of PTT dysfunction.
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Affiliation(s)
- Avneesh Chhabra
- Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
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Zaw H, Calder JDF. Operative management options for symptomatic flexible adult acquired flatfoot deformity: a review. Knee Surg Sports Traumatol Arthrosc 2010; 18:135-42. [PMID: 20049416 DOI: 10.1007/s00167-009-1015-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Maynou C, Naudi S, Staquet V, Parent S, Boniface O. Pied plat valgus statique de l'adulte (y compris synostoses congénitales). ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s0246-0521(10)51746-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Bowring B, Chockalingam N. A clinical guideline for the conservative management of tibialis posterior tendon dysfunction. Foot (Edinb) 2009; 19:211-7. [PMID: 20307479 DOI: 10.1016/j.foot.2009.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 08/24/2009] [Accepted: 08/24/2009] [Indexed: 02/04/2023]
Abstract
BACKGROUND Early and appropriate conservative treatment is considered essential to prevent progression of tibialis posterior tendon dysfunction (TPTD), with its potential long term disabling consequences and the need for surgical intervention. However, there is no consensus in the literature regarding the treatment of the disorder. This investigation aimed at developing a local clinical guideline for the conservative management of TPTD by a consensus development group. METHODOLOGY An action research methodology utilising the RAND modified Delphi approach was employed involving seven multidisciplinary consensus group participants. The guideline developed from this process was then sent for national evaluation via postal questionnaire. RESULTS Although a difference in opinion regarding certain aspects of the conservative management of TPTD was initially present, a local consensus was achieved following extensive discussion. 86% of survey respondents from other localities found the guideline useful but their comments, which were sometimes at odds with each other, revealed a lack of national consensus regarding the management of the condition. CONCLUSION This research project has provided empirical evidence that a local clinical guideline can be developed by a consensus group for the management of TPTD. However, the lack of national consensus regarding TPTD treatment found in this research study and as reflected in the published literature, would limit the transferability of this guideline to other localities. While, the guideline reported in this study could be used to inform the development of other national and international guidelines, different areas of expertise that emerged between professions highlighted the importance of employing a multidisciplinary group in the development of guidelines for the management of musculoskeletal conditions of the foot and ankle.
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Affiliation(s)
- Beverly Bowring
- Cornwall and Isles of Scilly Community Health Services, Penzance, Cornwall, UK
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Abstract
The adult acquired flatfoot is a challenging clinical entity with numerous procedures available to the surgeon for correction of the deformity. In a supple stage II flatfoot, naviculocuneiform arthrodesis with appropriate ancillary soft tissue augmentation and other adjunctive osseous procedures has proven effective with reproducible success. It may be used to balance a symptomatic flatfoot, re-establishing medial column stability and alignment while maintaining essential tri-tarsal joint motion. In addition to a review of the evidence-based medicine regarding this procedure, a detailed surgical technique is provided.
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Affiliation(s)
- Adam M Budny
- Department of Surgery, Saint Vincent Charity Hospital, 2351 East 22nd Street, Cleveland, OH 44115, USA.
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Chow HT, Chan KB, Lui TH. Tendoscopic debridement for stage I posterior tibial tendon dysfunction. Knee Surg Sports Traumatol Arthrosc 2005; 13:695-8. [PMID: 15952006 DOI: 10.1007/s00167-005-0635-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2004] [Accepted: 01/05/2005] [Indexed: 10/25/2022]
Abstract
Our objective is to assess whether the tendoscopic synovectomy is effective to control the stage I posterior tibial tendon dysfunction. Our study is a retrospective one. The participants, six patients with stage I posterior tibial tendon dysfunction, were treated with tendoscopy with synovectomy for the past 3 years. The results show that this is a safe procedure and we could achieve similar effectiveness as the traditional open procedure. There was no complication found. None of our patients have progressed to stage II or above posterior tibial tendon dysfunction. In conclusion, tendoscopic debridement is a minimal invasive surgery. It is effective to control the stage I posterior tibial tendon dysfunction. In addition, it had the advantages of smaller scars, less wound pain and a short hospital stay.
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Affiliation(s)
- Hung Tsan Chow
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, HKSAR, People's Republic of China.
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