Tags

Type your tag names separated by a space and hit enter

Peritalar Kinematics With Combined Deltoid-Spring Ligament Reconstruction in Simulated Advanced Adult Acquired Flatfoot Deformity.
Foot Ankle Int. 2020 Jun 04 [Online ahead of print]FA

Abstract

BACKGROUND

Adult acquired flatfoot deformity (AAFD) is a complex and progressive deformity involving the ligamentous structures of the medial peritalar joints. Recent anatomic studies demonstrated that the spring and deltoid ligaments form a greater medial ligament complex, the tibiocalcaneonavicular ligament (TCNL), which provides medial stability to the talonavicular, subtalar, and tibiotalar joints. The aim of this study was to assess the biomechanical effect of a spring ligament tear on the peritalar stability. The secondary aim was to assess the effect of TCNL reconstruction in restoration of peritalar stability in comparison with other medial stabilization procedures, anatomic spring or deltoid ligament reconstructions, in a cadaveric flatfoot model.

METHODS

Ten fresh-frozen cadaveric foot specimens were used. Reflective markers were mounted on the tibia, talus, navicular, calcaneus, and first metatarsal. Peritalar joint kinematics were captured by a multiple-camera motion capture system. Mild, moderate, and severe flatfoot models were created by sequential sectioning of medial capsuloligament complex followed by cyclic axial loading. Spring only, deltoid only, and combined deltoid-spring ligament (TCNL) reconstructions were performed. The relative kinematic changes were compared using 2-way analysis of variance (ANOVA).

RESULTS

Compared with the initial condition, we noted significantly increased valgus alignment of the subtalar joint of 5.1 ± 2.3 degrees (P = .031) and 5.8 ± 2.7 degrees (P < .01) with increased size of the spring ligament tear to create moderate to severe flatfoot, respectively. We noted an increased tibiotalar valgus angle of 5.1 ± 2.0 degrees (P = .03) in the severe model. Although all medial ligament reconstruction methods were able to correct forefoot abduction, the TCNL reconstruction was able to correct both the subtalar and tibiotalar valgus deformity (P = .04 and P = .02, respectively).

CONCLUSION

The TCNL complex provided stability to the talonavicular, subtalar, and tibiotalar joints. The combined deltoid-spring ligament (TCNL) reconstructions restored peritalar kinematics better than isolated spring or deltoid ligament reconstruction in the severe AAFD model.

CLINICAL RELEVANCE

The combined deltoid-spring ligament (TCNL) reconstruction maybe considered in advanced AAFD with medial peritalar instability: stage IIB with a large spring ligament tear or stage IV.

Authors+Show Affiliations

Department of Orthopaedic Surgery and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA.Department of Orthopaedic Surgery and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA.Department of Orthopaedic Surgery and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA.Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA.Center for Musculoskeletal Research, University of Rochester, Rochester, NY, USA.Department of Orthopaedic Surgery and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA.Department of Orthopaedic Surgery and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA.Department of Orthopaedic Surgery and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32495639

Citation

MacDonald, Ashlee, et al. "Peritalar Kinematics With Combined Deltoid-Spring Ligament Reconstruction in Simulated Advanced Adult Acquired Flatfoot Deformity." Foot & Ankle International, 2020, p. 1071100720929004.
MacDonald A, Ciufo D, Vess E, et al. Peritalar Kinematics With Combined Deltoid-Spring Ligament Reconstruction in Simulated Advanced Adult Acquired Flatfoot Deformity. Foot Ankle Int. 2020.
MacDonald, A., Ciufo, D., Vess, E., Knapp, E., Awad, H. A., Ketz, J. P., Flemister, A. S., & Oh, I. (2020). Peritalar Kinematics With Combined Deltoid-Spring Ligament Reconstruction in Simulated Advanced Adult Acquired Flatfoot Deformity. Foot & Ankle International, 1071100720929004. https://doi.org/10.1177/1071100720929004
MacDonald A, et al. Peritalar Kinematics With Combined Deltoid-Spring Ligament Reconstruction in Simulated Advanced Adult Acquired Flatfoot Deformity. Foot Ankle Int. 2020 Jun 4;1071100720929004. PubMed PMID: 32495639.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Peritalar Kinematics With Combined Deltoid-Spring Ligament Reconstruction in Simulated Advanced Adult Acquired Flatfoot Deformity. AU - MacDonald,Ashlee, AU - Ciufo,David, AU - Vess,Eric, AU - Knapp,Emma, AU - Awad,Hani A, AU - Ketz,John P, AU - Flemister,Adolph S, AU - Oh,Irvin, Y1 - 2020/06/04/ PY - 2020/6/5/entrez KW - adult acquired flatfoot deformity KW - deltoid ligament KW - spring ligament KW - tibiocalcaneonavicular ligament SP - 1071100720929004 EP - 1071100720929004 JF - Foot & ankle international JO - Foot Ankle Int N2 - BACKGROUND: Adult acquired flatfoot deformity (AAFD) is a complex and progressive deformity involving the ligamentous structures of the medial peritalar joints. Recent anatomic studies demonstrated that the spring and deltoid ligaments form a greater medial ligament complex, the tibiocalcaneonavicular ligament (TCNL), which provides medial stability to the talonavicular, subtalar, and tibiotalar joints. The aim of this study was to assess the biomechanical effect of a spring ligament tear on the peritalar stability. The secondary aim was to assess the effect of TCNL reconstruction in restoration of peritalar stability in comparison with other medial stabilization procedures, anatomic spring or deltoid ligament reconstructions, in a cadaveric flatfoot model. METHODS: Ten fresh-frozen cadaveric foot specimens were used. Reflective markers were mounted on the tibia, talus, navicular, calcaneus, and first metatarsal. Peritalar joint kinematics were captured by a multiple-camera motion capture system. Mild, moderate, and severe flatfoot models were created by sequential sectioning of medial capsuloligament complex followed by cyclic axial loading. Spring only, deltoid only, and combined deltoid-spring ligament (TCNL) reconstructions were performed. The relative kinematic changes were compared using 2-way analysis of variance (ANOVA). RESULTS: Compared with the initial condition, we noted significantly increased valgus alignment of the subtalar joint of 5.1 ± 2.3 degrees (P = .031) and 5.8 ± 2.7 degrees (P < .01) with increased size of the spring ligament tear to create moderate to severe flatfoot, respectively. We noted an increased tibiotalar valgus angle of 5.1 ± 2.0 degrees (P = .03) in the severe model. Although all medial ligament reconstruction methods were able to correct forefoot abduction, the TCNL reconstruction was able to correct both the subtalar and tibiotalar valgus deformity (P = .04 and P = .02, respectively). CONCLUSION: The TCNL complex provided stability to the talonavicular, subtalar, and tibiotalar joints. The combined deltoid-spring ligament (TCNL) reconstructions restored peritalar kinematics better than isolated spring or deltoid ligament reconstruction in the severe AAFD model. CLINICAL RELEVANCE: The combined deltoid-spring ligament (TCNL) reconstruction maybe considered in advanced AAFD with medial peritalar instability: stage IIB with a large spring ligament tear or stage IV. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/32495639/Peritalar_Kinematics_With_Combined_Deltoid-Spring_Ligament_Reconstruction_in_Simulated_Advanced_Adult_Acquired_Flatfoot_Deformity L2 - https://journals.sagepub.com/doi/10.1177/1071100720929004?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.