Spring Ligament Repair During Flatfoot Reconstruction APMA ... Ligament Repair During Flatfoot Reconstruction

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  • Spring Ligament Repair During Flatfoot Reconstruction: Why it Should be Addressed When

    Correcting Sagittal Plane Deformities

    Nicholas A. Campitelli, DPM, FACFAS APMA National

    7/28/2017

  • Nicholas A. Campiteli, DPM, FACFAS

    • Practice in multi-specialty group -Akron, OH

    • Board Certified in Foot Surgery and Reconstructive Rearfoot and Ankle Surgery

    • Consultant for Medline Foot & Ankle Surgery

  • Flat Foot Deformity

    • Frontal Plane

    • Transverse Plane

    • Sagittal Plane

  • PTTD

    • Posterior Tibial Tendon

    • Is it “dysfunctional”

  • Pathology • Spring Ligament

    • Attenuation leads to increased force on the posterior tibial tendon.

    DiDomenico LA, Thomas ZM, Fahim R. Addressing stage II posterior tibial tendon dysfunction: biomechanically repairing the osseous structures without the need of performing the flexor digitorum longus transfer. Clin Podiatr Med Surg. 2014 Jul;31(3):391-404.

    Hentges MJ, Moore KR, Catanzariti AR, Derner R. Procedure selection for the flexible adult acquired flatfoot deformity. Clin Podiatr Med Surg. 2014 Jul;31(3):363-79.

  • Spring Ligament

    • Static Support of Medial Longitudinal Arch

    • Two Distinct Fibers

  • Calcaneous

    TalusNavicular

    superomedial fibers

    infer ior fi

    bers

  • CalcaneousTalus

    Navicular

  • http://radsource.us/spring-ligament-tear/

  • Pathology

    • spring ligament abnormality = flatfoot deformity

    • Equal importance posterior tibial tendon dysfunction

    Williams BR, Ellis SJ, Deyer TW, Pavlov H, Deland JT. Reconstruction of the spring ligament using a peroneus longus autograft tendon transfer. Foot Ankle

    Int. 2010 Jul;31(7):567-77.

  • Pathology

    • Spring Ligament and PT Tendon play essential role in elastic support of joint complex

    • Progressive strain on the mid- plantar sling is the most common cause of flatfoot, causing midfoot abduction

    Toullec E. Adult flatfoot. Orthop Traumatol Surg Res. 2015 Feb;101(1 Suppl):S11-7. doi: 10.1016

  • Pathology

    • Regardless of the etiology, literature is demonstrating the spring ligament is failing and becoming attenuated, needs fixed

    • The most important static structure to be repaired for AAFD is the spring ligament.

    Wei S, Cai X, Yun G. [Progress in soft tissue reconstruction of adult-acquired flatfoot deformity]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Oct;26(10):1259-62.

  • Posterior Tibial Tendon

    • May Still be functioning

  • Spring Ligament

    • Soft tissue structure most open to fail

    • TN Joint Deformity

    Lee WC, Yi Y. Spring ligament reconstruction using the autogenous flexor hallucis longus tendon. Orthopedics. 2014 Jul;37(7):467-71.

  • Isolated Spring Ligament Rupture

    • Acquired pes planus is due to a failure of the osseoligamentous complex

    • Could still perform a single heel rise

    Borton DC, Saxby TS. Tear of the plantar calcaneonavicular (spring) ligament causing flatfoot. A case report. J Bone Joint Surg Br. 1997 Jul;79(4):641-3.

  • Procedure Selection

    • Lateral Column Lengthening

    • MDCO with FLD Transfer

    • Spring Ligament Repair

    Zanolli DH, Glisson RR, Nunley JA 2nd, Easley ME. Biomechanical assessment of flexible flatfoot correction: comparison of techniques in a cadaver model. J Bone

    Joint Surg Am. 2014 Mar 19;96(6):e45.

  • MDCO

    • Reduces the load

    • adding FDL transfer small effect

    Arangio GA, Salathe EP. A biomechanical analysis of posterior tibial tendon dysfunction, medial displacement calcaneal osteotomy and flexor digitorum longus

    transfer in adult acquired flat foot. Clin Biomech (Bristol, Avon). 2009 May;24(4):385-90.

  • Arthrodesis

  • Spring Ligament Repair

  • Spring Ligament Repair

  • Spring Ligament Repair

  • Spring Ligament Repair

  • Summary

    • Repair needs focused on the stage and type of deformity.

    • Talonavicular Joint needs addressed

    • Flexible Need to repair Spring Ligament Complex

  • Thank You

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