Comparison of Proximal and Distal Oblique Second Metatarsal Osteotomies with Varying Achilles Tendon Tension

Aydogan, Umur; Moore, Blake E.; Andrews, Seth; Roush, Evan P.; Kunselman, Allen R.; Lewis, Gregory S.

doi:10.2106/jbjs.o.00216

Cited by 6 publications

(5 citation statements)

References 23 publications

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“…The polyvinyl chloride tube, encompassing the tibia and fibula, was fastened to the vertical actuator of a servohydraulic test frame (FlexTest 40; MTS), as performed in previous work. 5 - 7 , 24 , 37 The braided line, whipstitched through the Achilles, was attached to a pulley mechanism of a pneumatic actuator to apply a tensile force. 24 The foot rested on a plate supported by bearings that allowed translation and rotation in the horizontal plane perpendicular to the applied force.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical Comparison of Fiber Tape Device Versus Transarticular Screws for Ligamentous Lisfranc Injury in a Cadaveric Model

et al. 2022

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Background: The preferred method of fixation and surgical treatment for ligamentous Lisfranc injuries is controversial. Transarticular screws, bridge plating, fusion, and flexible fixation have been described, yet none have demonstrated superiority. Furthermore, screw fixation and plating often require secondary surgery to remove implants, leading surgeons to seek alternative fixation methods. Purpose: To compare transarticular screws and a fiber tape construct under a spectrum of biomechanical loads by evaluating the diastasis at 3 joints in the Lisfranc complex. Study Design: Controlled laboratory study. Methods: Eight matched pairs of fresh, previously frozen lower extremity cadaveric specimens were fixed with either 2 cannulated transarticular crossed screws or a fiber tape construct with a supplemental intercuneiform limb. The diastasis between bones was measured at 3 midfoot joints in the Lisfranc complex: the Lisfranc articulation, the second tarsometatarsal joint, and the intercuneiform joint. Measurements were obtained for the preinjured, injured, and fixation conditions under static loading at 50% donor body weight. Specimens then underwent cyclic loading performed at 1 Hz and 100 cycles, based on 100-N stepwise increases in ground-reaction force from 100 to 2000 N, to simulate postoperative loading from the partial weightbearing stage to high-energy activities. Failure of fixation was defined as diastasis ≥2 mm at the Lisfranc articulation (second metatarsal–medial cuneiform joint). Results: There were no significant differences in diastasis detected at the Lisfranc articulation or the intercuneiform joint throughout all loading cycles between groups. All specimens endured loading up to 50% body weight + 1400 N. Up to and including this stage, there were 2 failures in the cannulated transarticular crossed-screw group and none in the fiber tape group. Conclusion: The fiber tape construct with a supplemental intercuneiform limb, which does not require later removal, may provide comparable biomechanical stability to cannulated transarticular crossed screws, even at higher loads. Clinical Relevance: Ligamentous Lisfranc injuries are common among athletes. Therefore, biomechanical evaluations are necessary to determine stable constructs that can limit the time to return to play. This study compares the biomechanical stability of 2 methods of fixation for ligamentous injury through a wide spectrum of loading, including those experienced by athletes.

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Section: Methodsmentioning

confidence: 99%

Biomechanical Comparison of Fiber Tape Device Versus Transarticular Screws for Ligamentous Lisfranc Injury in a Cadaveric Model

et al. 2022

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“…A previously described mechanical loading setup by our institution was used. 2,3,11 Briefly, the tibia potting was fastened to the vertical actuator of a servohydraulic test frame (FlexTest 40, MTS, Eden Prairie, MN). Tension was applied to the Achilles with a pneumatic cylinder.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical Evaluation of Spring Ligament Augmentation With the FiberTape Device in a Cadaveric Flatfoot Model

et al. 2019

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Background: The structural importance of the spring ligament complex in arch stability has been described. Furthermore, the pathology of this complex is often noted in patients with posterior tibial tendon dysfunction. The purpose of this biomechanical study was to evaluate spring ligament repair alone versus augmentation with the FiberTape device in a cadaveric flatfoot model. Methods: Eight paired, below-the-knee, cadaveric specimens underwent flatfoot creation and reconstruction. The experimental group received augmentation with FiberTape (InternalBrace). After potting, specimens were loaded statically to measure talonavicular contact pressures and flatfoot correction. Cyclic loading was performed in a stepwise fashion. Loading was performed at 1 Hz and 100 cycles, at 100-N intervals from 500 to 1800 N, with the Achilles tendon also loaded to simulate weightbearing in the postoperative period. Results: Control specimen analysis demonstrated failures of 8 of 8 (100%) spring ligament suture repairs, occurring through suture cut-through (5 specimens), suture fatigue and elongation (2), or knot failure (1). One of 8 (12.5%) FiberTape-augmented repairs failed after cyclic loading. The difference in number of repair failures was statistically significant between the 2 groups ( P = .0014). Analysis revealed that at forces of 1600 N ( P = .03) and 1700 N ( P = .02) there were statistically significant differences between the FiberTape-augmented group and the control group, with a greater collapse in the lateral Meary talo–first metatarsal angle in the controls. There was no significant difference or abnormal increase in contact pressures of the talonavicular joint in both groups. Conclusion: FiberTape augmentation of the spring ligament appears biomechanically safe and effective under cyclic loading. Clinical relevance: Spring ligament augmentation with this device may be another biomechanically safe and reasonable treatment modality for surgeons during flatfoot reconstruction. It is possible that early protected weightbearing after these procedures may be performed.

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“…The biomechanical effects of the osteotomies themselves without plantar fascia release are described in a separate report. 17 …”

Section: Methodsmentioning

confidence: 99%

“…They were then assigned randomly to modified distal oblique metatarsal osteotomy or proximal oblique osteotomy with equal numbers of left and right feet in each group. The biomechanical effects of the osteotomies themselves without plantar fascia release are described in a separate report …”

Section: Methodsmentioning

confidence: 99%

“…All surgeries were performed by the senior foot and ankle fellowship‐trained orthopaedic surgeon or by a clinical foot and ankle fellow under his supervision. As we previously described in additional detail, for the distal modified oblique osteotomy, the second metatarsal head was exposed after a 3 cm incision was made over the metatarsophalangeal joint. A classic distal metatarsal oblique osteotomy was performed using a 1 mm thick bladed micro‐sagittal saw, parallel to the floor, starting 2 mm distal to the articular cartilage.…”

Section: Methodsmentioning

confidence: 99%

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Biomechanical consequences of adding plantar fascia release to metatarsal osteotomies: Changes in forefoot plantar pressures

Aydogan

Roush

Moore

et al. 2016

Journal Orthopaedic Research

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Destruction of the normal metatarsal arch by a long metatarsal is often a cause for metatarsalgia. When surgery is warranted, distal oblique or proximal dorsiflexion osteotomies of the long metatarsal bones are commonly used. The plantar fascia has anatomical connection to all metatarsal heads. There is controversial scientific evidence on the effect of plantar fascia release on forefoot biomechanics. In this cadaveric biomechanical study, we hypothesized that plantar fascia release would augment the plantar metatarsal pressure decreasing effects of two common second metatarsal osteotomy techniques. Six matched pairs of foot and ankle specimens were mounted on a pressure mat loading platform. Two randomly assigned surgery groups, which had received either distal oblique or proximal dorsiflexion osteotomy of the second metatarsal, were evaluated before and after plantar fasciectomy. Specimens were loaded up to a ground reaction force of 400 N at varying Achilles tendon forces. Average pressures, peak pressures, and contact areas were analyzed. Supporting our hypothesis, average pressures under the second metatarsal during 600 N Achilles load were decreased by plantar fascia release following proximal osteotomy (p<.05). However contrary to our hypothesis, peak pressures under the second metatarsal were significantly increased by plantar fascia release following modified distal osteotomy, under multiple Achilles loading conditions (p<.05).

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Comparison of Proximal and Distal Oblique Second Metatarsal Osteotomies with Varying Achilles Tendon Tension

Abstract: The findings of this biomechanical study help shed light on which of the common second metatarsal osteotomies are best for decreasing plantar pressures.

Cited by 6 publications

References 23 publications

Biomechanical Comparison of Fiber Tape Device Versus Transarticular Screws for Ligamentous Lisfranc Injury in a Cadaveric Model

Biomechanical Comparison of Fiber Tape Device Versus Transarticular Screws for Ligamentous Lisfranc Injury in a Cadaveric Model

Biomechanical Evaluation of Spring Ligament Augmentation With the FiberTape Device in a Cadaveric Flatfoot Model

Biomechanical consequences of adding plantar fascia release to metatarsal osteotomies: Changes in forefoot plantar pressures

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