Comparative Study of Spring Ligament Reconstructions Using Either Hamstring Allograft or Synthetic Ligament Augmentation

Heyes, Gavin; Swanton, Eric; Vosoughi, Amir Reza; Mason, Lyndon; Molloy, Andrew

doi:10.1177/1071100720917375

Cited by 11 publications

(12 citation statements)

References 49 publications

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“…4 However, there have been few in vivo studies demonstrating the efficacy of SLR in PCFD, and those that do exist are limited by the small number of patients included in each study or their short-term follow-up. 6,20 We believe that the current study represents the largest cohort of SLR to date, as well as the longest follow-up of allograft reconstruction technique.…”

Section: Discussionmentioning

confidence: 94%

“…In another study, Heyes et al compared 17 SLRs utilizing synthetic ligament augmentation to 16 reconstructions using hamstring allograft, with a minimum of 1 year of follow-up. 20 In their study, synthetic ligament augmentation resulted in superior patient-reported outcomes compared to allograft reconstruction, and 2 patients in the allograft group required revision due to pain and deformity recurrence. However, their technique did not include the tibionavicular limb, unlike the technique described in this article.…”

Section: Discussionmentioning

confidence: 96%

“…1,4,6,13,16,32 Cadaveric studies have demonstrated its isolated effect, 4,9,17 and clinical series have demonstrated favorable abduction correction and improved patient-reported outcomes when SLR was combined with PCFD reconstructive procedures. 6,20,32 However, most prior studies are limited by short-term follow-up data 6,20 ; thus, longer-term outcomes of SLR are necessary to determine whether SLR can maintain correction over time without requiring fusion of the TN joint.…”

Section: Introductionmentioning

confidence: 99%

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Medium- to Long-term Results of Nonanatomic Spring Ligament Reconstruction Using an Allograft Tendon in Progressive Collapsing Foot Deformity With Severe Abduction Deformity

et al. 2023

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Background: Spring ligament reconstruction (SLR) has been suggested as an adjunct to other reconstructive procedures to potentially avoid talonavicular joint fusion in progressive collapsing foot deformity (PCFD) with severe abduction deformity. Most clinical reports present short-term follow-up data and a small number of patients. The purpose of this study was to examine the medium- to long-term outcomes of an SLR using allograft tendon augmentation as part of PCFD surgical reconstruction. This study to our knowledge represents the largest number of patients and the longest follow-up to date. Methods: This study retrospectively reviewed 26 patients (27 feet, mean age of 61.4 years) who underwent SLR with allograft tendon as part of PCFD reconstruction. The mean follow-up of the cohort was 8 years (range, 5-13.4). Radiographic evaluation consisted of 5 parameters including talonavicular coverage angle (TNC), with the maintenance of correction being evaluated by comparing parameters from the early postoperative period (mean: 11.6 months, range, 8-17) to final follow-up. Foot and Ankle Outcome Score (FAOS) and patient satisfaction questionnaires were collected at final follow-up. Conversion to talonavicular or subtalar fusion was considered as a failure. Results: Final radiographs demonstrated successful abduction correction, with the mean TNC improving from 43.7 degrees preoperatively to 14.1 degrees postoperatively (P < .0001). All other radiographic parameters improved significantly and exhibited maintenance of the correction. All FAOS subscales showed significant improvement. Responses to the satisfaction questionnaire were received from all except 1 patient, of whom 88.5% (23/26) were satisfied with the results, 96.2% (25/26) would undergo the surgery again, and 88.5% (23/26) would recommend the surgery. Eight feet (29.6%) required painful hardware removal and 1 (3.7%) developed nonunion of the lateral column lengthening osteotomy. No patient required conversion to talonavicular or subtalar fusion. Conclusion: This study demonstrates favorable medium- to long-term outcomes following PCFD reconstruction including an SLR with allograft tendon augmentation. Level of Evidence: Level IV, case series.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Medium- to Long-term Results of Nonanatomic Spring Ligament Reconstruction Using an Allograft Tendon in Progressive Collapsing Foot Deformity With Severe Abduction Deformity

et al. 2023

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“…7,15,21,27 In the last decade, there has been an increasing appreciation on the importance of the ligamentous structures of the medial longitudinal arch. 17,29 A consensus paper was developed leading to renaming of the condition, but the importance of the distal aspect of the MLA was not discussed. 28 Nevertheless, studies on hallux valgus surgery have identified pes planus deformity as a major factor in recurrence of hallux valgus following reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Association of Fusion of the First Metatarsophalangeal Joint and Pes Planus Deformity Correction

et al. 2023

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Background There has been scant investigation on the relationship between the distal aspect of the medial longitudinal arch and pes planus deformity. The aim of this study was to investigate whether the reduction and stabilization of the distal aspect of the medial longitudinal arch through fusion of the first metatarsophalangeal joint (MTPJ) can subsequently improve pes planus deformity parameters. This could be useful in both further understanding the role of the distal medial longitudinal arch in patients with pes planus and planning operative intervention in patients with multifactorial medial longitudinal arch problems. Methods: A retrospective cohort study was undertaken between January 2011 and October 2021, including patients undergoing first MTPJ fusion with a pes planus deformity on weightbearing preoperative radiographs. These were compared to postoperative images, and multiple pes planus measurements were taken for comparison. Results: A total of 511 operations were identified for further analysis, with 48 feet meeting the inclusion criteria. There was a statistically significant reduction identified between the pre- and postoperative measurements of Meary angle (3.75 degrees, 95% CI 2.9-6.47 degrees) and talonavicular coverage angle (1.48 degrees, 95% CI 1.09-3.44 degrees). There was a statistically significant increase between the pre- and postoperative measurements of calcaneal pitch angle (2.32 degrees, 95% CI 0.24-4.41 degrees) and medial cuneiform height (1.25 mm, 95% CI 0.6-1.92 mm). Reduced intermetatarsal angle was significantly associated with an increase in first MTPJ angle postfusion. Many of the measurements made were found “almost perfectly” reproducible by the Landis and Koch description. Conclusion: Our results demonstrate that fusion of the first MTPJ is associated with improvement of medial longitudinal arch parameters of a pes planus deformity but not to levels considered to be clinically normal. Therefore, the distal aspect of the medial longitudinal arch could, to some degree, be a feature in the pes planus deformity etiology. Level of Evidence: Level III, retrospective case control study.

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“…Heyes et al 36 compared synthetic augmentation to semitendinosus allograft. Their synthetic technique involved proximal fixation to the sustentaculum tali but distal fixation to the medial cuneiform instead of the navicular to additionally reconstruct the naviculocuneiform ligament.…”

Section: Treatmentmentioning

confidence: 99%

Spring Ligament Reconstruction for Progressive Collapsing Foot Deformity: Contemporary Review

2023

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The spring ligament is one of the main stabilizers of the medial arch of the foot and the primary static supporter of the talonavicular joint. Attenuation or rupture of this ligament is thought to play a central role in the pathophysiology of progressive collapsing foot deformity. Traditional correction of flexible flatfoot consists of posterior tibial tendon augmentation along with various osteotomies or hindfoot fusions. Repair or reconstruction of the spring ligament has not been as widely pursued. In recent years, newer techniques have been explored and may improve outcomes of traditional procedures, or possibly entirely replace some osteotomies. Combined spring-deltoid ligament reconstruction is also gaining traction as a viable technique, particularly as the ankle begins to deform into valgus. This review summarizes the variety of nonanatomic and anatomic reconstruction techniques that have been described, including autologous tendon transfers, allografts, and synthetic augmentation. Although many have only been characterized in biomechanical cadaver studies, this article reviews preliminary clinical studies that have shown promising results. There is a need for more high-quality studies evaluating the clinical, radiographic, and patient-reported outcomes following spring ligament reconstruction.

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Comparative Study of Spring Ligament Reconstructions Using Either Hamstring Allograft or Synthetic Ligament Augmentation

Cited by 11 publications

References 49 publications

Medium- to Long-term Results of Nonanatomic Spring Ligament Reconstruction Using an Allograft Tendon in Progressive Collapsing Foot Deformity With Severe Abduction Deformity

Medium- to Long-term Results of Nonanatomic Spring Ligament Reconstruction Using an Allograft Tendon in Progressive Collapsing Foot Deformity With Severe Abduction Deformity

Association of Fusion of the First Metatarsophalangeal Joint and Pes Planus Deformity Correction

Spring Ligament Reconstruction for Progressive Collapsing Foot Deformity: Contemporary Review

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