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Spring ligament tear decreases static stability of the ankle joint

      Highlights

      • Spring ligament tear studied to determine its effect on joint static forces.
      • Repair of the medial ligament complex utilizing a two-limbed reconstruction
      • Two-limbed reconstruction to assess ability to restore static joint forces

      Abstract

      Background

      Spring ligament tear is often found in advanced adult acquired flatfoot deformity and its reconstruction in conjunction with the deltoid ligament has been proposed to restore the tibiotalar and talonavicular joint stability. The aim of the present study is to determine the effect of spring ligament injury and subsequent reconstruction on static joint reactive force using a non-invasive method of measurement.

      Methods

      Ten fresh-frozen human cadaveric lower legs were disarticulated at the knee joint. Static joint reactive force of the tibiotalar and talonavicular joint were measured at baseline, after spring ligament injury, and after ligament reconstruction. Reconstruction consisted of a forked semitendinosis allograft with dual limbs to reconstruct the tibionavicular and tibiocalcaneal ligaments.

      Findings

      The mean baseline joint reactive force of the tibiotalar and talonavicular joints were 37.2 N + 8.1 N and 13.4 N + 4.2 N, respectively. The spring ligament injury model resulted in a significant 29% decrease in tibiotalar joint reactive force. Reconstruction of the tibionavicular limb resulted in a significant increase in tibiotalar and talonavicular joint reactive force compared to those seen in the injury state. Furthermore, the addition of the tibiocalcaneal limb significantly increased tibiotalar joint reactive force compared to those results obtained from the injury state and the tibionavicular limb alone.

      Interpretation

      This is the first study to demonstrate diminished tibiotalar static joint reactive force in a spring ligament injury model with subsequent joint reactive force restoration using two-limbed reconstruction of the deltoid and spring ligament.
      Level of Evidence: Biomechanical Study.

      Keywords

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      References

        • Baxter J.R.
        • Lamothe J.M.
        • Walls R.J.
        • Prado M.P.
        • Gilbert S.L.
        • Deland J.T.
        Reconstruction of the medial talonavicular joint in simulated flatfoot deformity.
        Foot Ankle Int. 2015; 36: 424-429
        • Bolt P.M.
        • Coy S.
        • Toolan B.C.
        A comparison of lateral column lengthening and medial translational osteotomy of the calcaneus for the reconstruction of adult acquired flatfoot.
        Foot Ankle Int. 2007; 28: 1115-1123
        • Campbell K.J.
        • Michalski M.P.
        • Wilson K.J.
        • Goldsmith M.T.
        • Wijdicks C.A.
        • LaPrade R.F.
        • Clanton T.O.
        The ligament anatomy of the deltoid complex of the ankle: a qualitative and quantitative anatomical study.
        J. Bone Joint Surg. Am. 2014; 96: e62
        • Campbell S.T.
        • Reese K.A.
        • Ross S.D.
        • McGarry M.H.
        • Leba T.B.
        • Lee T.Q.
        Effect of graft shape in lateral column lengthening on tarsal bone position and subtalar and talonavicular contact pressure in a cadaveric flatfoot model.
        Foot Ankle Int. 2014; 35: 1200-1208
        • Canham C.D.
        • Schreck M.J.
        • Maqsoodi N.
        • Doolittle M.
        • Olles M.
        • Elfar J.C.
        A nondestructive, reproducible method of measuring joint reaction force at the distal radioulnar joint.
        J. Hand. Surg. [Am.]. 2015; 40: 1138-1144
        • Canham C.D.
        • Schreck M.J.
        • Maqsoodi N.
        • Messing S.
        • Olles M.
        • Elfar J.C.
        Distal radioulnar joint reaction force following ulnar shortening: diaphyseal osteotomy versus wafer resection.
        J. Hand. Surg. [Am.]. 2015; 40: 2206-2212
        • Cromeens B.P.
        • Kirchhoff C.A.
        • Patterson R.M.
        • Motley T.
        • Stewart D.
        • Fisher C.
        • Reeves R.E.
        An attachment-based description of the medial collateral and spring ligament complexes.
        Foot Ankle Int. 2015; 36: 710-721
        • Deland J.T.
        Adult-acquired flatfoot deformity.
        J. Am. Acad. Orthop. Surg. 2008; 16: 399-406
        • Deland J.T.
        • de Asla R.J.
        • Sung I.H.
        • Ernberg L.A.
        • Potter H.G.
        Posterior tibial tendon insufficiency: which ligaments are involved?.
        Foot Ankle Int. 2005; 26: 427-435
        • Grunfeld R.
        • Oh I.
        • Flemister A.S.
        • Ketz J.P.
        Reconstruction of the deltoid-spring ligament: tibiocalcaneonavicular ligament complex.
        Tech. Foot Ankle Surg. 2016; 15: 39-46
        • Haskell A.
        • Mann R.A.
        Biomechanics of the foot and ankle.
        in: Coughlin M. Saltzman C. R.B., A Mann's Surgery of the Foot and Ankle. 9th ed. Elsevier Saunders, Philadelphia, PA2014: 20
        • Ho B.
        • Maqsoodi N.
        • Vasconcellos D.
        • Osman W.
        • Fowler X.
        • Elfar J.C.
        • Olles M.
        • Ketz J.P.
        • Flemister A.S.
        • Oh I.
        Noninvasive Measurement of the Native Foot and Ankle Joint Reaction Force.
        2018 (In review)
        • Hunt K.J.
        • Goeb Y.
        • Behn A.W.
        • Criswell B.
        • Chou L.
        Ankle joint contact loads and displacement with progressive syndesmotic injury.
        Foot Ankle Int. 2015; 36: 1095-1103
        • Momberger N.
        • Morgan J.M.
        • Bachus K.N.
        • West J.R.
        Calcaneocuboid joint pressure after lateral column lengthening in a cadaveric planovalgus deformity model.
        Foot Ankle Int. 2000; 21: 730-735
        • Niki H.
        • Hirano T.
        • Okada H.
        • Beppu M.
        Outcome of medial displacement calcaneal osteotomy for correction of adult-acquired flatfoot.
        Foot Ankle Int. 2012; 33: 940-946
        • Orr J.D.
        • Nunley 2nd, J.A.
        Isolated spring ligament failure as a cause of adult-acquired flatfoot deformity.
        Foot Ankle Int. 2013; 34: 818-823
        • Williams B.R.
        • Ellis S.J.
        • Deyer T.W.
        • Pavlov H.
        • Deland J.T.
        Reconstruction of the spring ligament using a peroneus longus autograft tendon transfer.
        Foot Ankle Int. 2010; 31: 567-577
        • Xia J.
        • Zhang P.
        • Yang Y.F.
        • Zhou J.Q.
        • Li Q.M.
        • Yu G.R.
        Biomechanical analysis of the calcaneocuboid joint pressure after sequential lengthening of the lateral column.
        Foot Ankle Int. 2013; 34: 261-266
        • Yang L.
        • Cai G.
        • Coulton L.
        • Saleh M.
        Knee joint reaction force during tibial diaphyseal lengthening: a study on a rabbit model.
        J. Biomech. 2004; 37: 1053-1059