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Finite element analysis of secondary effect of midfoot fusions on the spring ligament in the management of adult acquired flatfoot.
Clin Biomech (Bristol, Avon). 2020 Jun; 76:105018.CB

Abstract

BACKGROUND

Surgical treatment of adult acquired flatfoot deformity can involve arthrodesis of the midfoot to stabilize the medial column. Few experimental studies have assessed the biomechanical effects of these fusions, because of the difficulty of measuring these parameters in cadavers. Our objective was to quantify the biomechanical stress caused by various types of midfoot arthrodesis on the Spring ligament. To date this is not known.

METHODS

An innovative finite element model was used to evaluate flatfoot scenarios treated with various combinations of midfoot arthrodesis. All the bones, cartilages and tissues related to adult acquired flatfoot deformity were included, respecting their biomechanical characteristics. The stress changes on the Spring ligament were quantified. Both foot arch lengthening and falling were measured for each of the midfoot arthrodeses evaluated.

FINDINGS

Arthrodesis performed for stabilization of the talonavicular joint leads to a higher decrease in stress on the Spring ligament. Talonavicular fusion generated a Spring ligament stress decrease of about 61% with respect to the reference case (without any fusion). However, fusing the naviculocuneiform joints leads to an increase in the stress on the Spring ligament.

INTERPRETATION

This important finding has been unknown to date. We advocate caution regarding fusion of the naviculocuneiform joint as it leads to increased stresses across the Spring ligament and therefore accelerates the development of planovalgus.

Authors+Show Affiliations

Biomedical Engineering Deparment, Universidad de los Andes, Colombia; Universidad Espíritu Santo, Ecuador.Queen Elizabeth Hospital, Kings Lynn, Norfolk, UK.Applied Mechanics and Bioengineering Group (AMB), Aragón Institute of Engineering Research (I3A), Universidad de Zaragoza, Spain. Electronic address: crisjavri@gmail.com.Orthopaedics and Trauma Department, Surgery Department - Hospital Universitario Infanta Leonor, Madrid, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32413775

Citation

Cifuentes-De la Portilla, Christian, et al. "Finite Element Analysis of Secondary Effect of Midfoot Fusions On the Spring Ligament in the Management of Adult Acquired Flatfoot." Clinical Biomechanics (Bristol, Avon), vol. 76, 2020, p. 105018.
Cifuentes-De la Portilla C, Pasapula C, Larrainzar-Garijo R, et al. Finite element analysis of secondary effect of midfoot fusions on the spring ligament in the management of adult acquired flatfoot. Clin Biomech (Bristol, Avon). 2020;76:105018.
Cifuentes-De la Portilla, C., Pasapula, C., Larrainzar-Garijo, R., & Bayod, J. (2020). Finite element analysis of secondary effect of midfoot fusions on the spring ligament in the management of adult acquired flatfoot. Clinical Biomechanics (Bristol, Avon), 76, 105018. https://doi.org/10.1016/j.clinbiomech.2020.105018
Cifuentes-De la Portilla C, et al. Finite Element Analysis of Secondary Effect of Midfoot Fusions On the Spring Ligament in the Management of Adult Acquired Flatfoot. Clin Biomech (Bristol, Avon). 2020;76:105018. PubMed PMID: 32413775.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Finite element analysis of secondary effect of midfoot fusions on the spring ligament in the management of adult acquired flatfoot. AU - Cifuentes-De la Portilla,Christian, AU - Pasapula,Chandra, AU - Larrainzar-Garijo,Ricardo, AU - Bayod,Javier, Y1 - 2020/05/06/ PY - 2019/06/18/received PY - 2020/03/22/revised PY - 2020/04/21/accepted PY - 2020/5/16/pubmed PY - 2020/5/16/medline PY - 2020/5/16/entrez KW - Biomechanics KW - FE modeling KW - Flatfoot KW - Midfoot arthrodeses KW - Spring ligament SP - 105018 EP - 105018 JF - Clinical biomechanics (Bristol, Avon) JO - Clin Biomech (Bristol, Avon) VL - 76 N2 - BACKGROUND: Surgical treatment of adult acquired flatfoot deformity can involve arthrodesis of the midfoot to stabilize the medial column. Few experimental studies have assessed the biomechanical effects of these fusions, because of the difficulty of measuring these parameters in cadavers. Our objective was to quantify the biomechanical stress caused by various types of midfoot arthrodesis on the Spring ligament. To date this is not known. METHODS: An innovative finite element model was used to evaluate flatfoot scenarios treated with various combinations of midfoot arthrodesis. All the bones, cartilages and tissues related to adult acquired flatfoot deformity were included, respecting their biomechanical characteristics. The stress changes on the Spring ligament were quantified. Both foot arch lengthening and falling were measured for each of the midfoot arthrodeses evaluated. FINDINGS: Arthrodesis performed for stabilization of the talonavicular joint leads to a higher decrease in stress on the Spring ligament. Talonavicular fusion generated a Spring ligament stress decrease of about 61% with respect to the reference case (without any fusion). However, fusing the naviculocuneiform joints leads to an increase in the stress on the Spring ligament. INTERPRETATION: This important finding has been unknown to date. We advocate caution regarding fusion of the naviculocuneiform joint as it leads to increased stresses across the Spring ligament and therefore accelerates the development of planovalgus. SN - 1879-1271 UR - https://www.unboundmedicine.com/medline/citation/32413775/Finite_element_analysis_of_secondary_effect_of_midfoot_fusions_on_the_spring_ligament_in_the_management_of_adult_acquired_flatfoot L2 - https://linkinghub.elsevier.com/retrieve/pii/S0268-0033(20)30127-3 DB - PRIME DP - Unbound Medicine ER -
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