Indications for Deltoid and Spring Ligament Reconstruction in Progressive Collapsing Foot Deformity

Deland, Jonathan T.; Ellis, Scott J.; Day, Jonathan; Hintermann, Beat; Myerson, Mark S.; Sangeorzan, Bruce J.; Schon, Lew C.; Thordarson, David B.; Johnson, Jeffrey E.

doi:10.1177/1071100720950742

Cited by 30 publications

(34 citation statements)

References 31 publications

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“…That may suggest not only the facility in recognizing this deformity in conventional radiographs but also the chronicity of part of our sample referenced to a quaternary hospital, sustaining a combination of advanced deformities leading to ankle involvement at the time of presentation. 4,19,32…”

Section: Discussionmentioning

confidence: 99%

Intra- and Interobserver Reliability of the New Classification System of Progressive Collapsing Foot Deformity

et al. 2021

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Background: Historical concept of flatfoot as posterior tibial tendon dysfunction (PTTD) has been questioned. Recently, the consensus group published a new classification system and recommended renaming PTTD to Progressive Collapsing Foot Deformity (PCFD). The new PCFD classification could be effective in providing comprehensive information on the deformity. To date, there has been no study reporting intra- and interobserver reliability and the frequency of each class in PCFD classification. Methods: This was a single-center, retrospective study conducted from prospectively collected registry data. A consecutive cohort of PCFD patients evaluated from February 2015 to October 2020 was included, consisting of 92 feet in 84 patients. Classification of each patient was made using characteristic clinical and radiographic findings by 3 independent observers. Frequencies of each class and subclass were assessed. Intraobserver and inteobserver reliabilities were analyzed with Cohen kappa and Fleiss kappa, respectively. Results: Mean sample age was 54.4, 38% was male and 62% were female. 1ABC (25.4%) was the most common subclass, followed by 1AC (8.7%) and 1ABCD (6.9%). Only a small percentage of patients had isolated deformity. Class A was the most frequent component (89.5%), followed by C in 86.2% of the cases. Moderate interobserver reliability (Fleiss kappa = 0.561, P < .001, 95% CI 0.528-0.594) was found for overall classification. Very good intraobserver reliability was found (Cohen kappa = 0.851, P < .001, 95% CI 0.777-0.926). Conclusion: Almost half (49.3%) of patients had a presentation dominantly involving the hindfoot (A) with various combinations of midfoot and/or forefoot deformity (B), (C) with or without subtalar joint involvement (D). The new system may cover all possible combinations of the PCFD, providing a comprehensive description and guiding treatment in a systematic and individualized manner, but this initial study suggests an opportunity to improve overall interobserver reliability. Level of Evidence: Level III, retrospective diagnostic study.

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Section: Discussionmentioning

confidence: 99%

Intra- and Interobserver Reliability of the New Classification System of Progressive Collapsing Foot Deformity

et al. 2021

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“…29 Flatfoot induces an increase in stress on the deltoid ligament, which may expand and raise problems in the management of these patients. 12-14,25,48 These difficulties may be encountered either in cases of spring ligament reconstruction using the anterior part of the TCL due to a decrease in the biomechanical qualities of the transplant, 12,13 or cases of triple arthrodesis with a high risk of external tibiotalar joint failure with progressive decompensation of the talar valgus tilt. 25,48 More recently, combined reconstruction techniques have been described, with promising functional results.…”

Section: Discussionmentioning

confidence: 99%

“…25,48 More recently, combined reconstruction techniques have been described, with promising functional results. 5,13,14,41…”

Section: Discussionmentioning

confidence: 99%

“…25,48 More recently, combined reconstruction techniques have been described, with promising functional results. 5,13,14,41 In addition to the clinical examination or arthroscopic examination, 2,35 magnetic resonance imaging is the gold standard for imaging ankle ligaments. 37 Another cross-sectional imaging alternative is the computed tomographic scan, which has shown its usefulness in daily clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…This examination is available to orthopaedic surgeons, allowing reliable and reproducible monitoring of the SWS of the various ligaments constituting the medial collateral plane. In addition to diagnosis, it could also be used in the choice of ligament transplant or even the adjustment of its tension intraoperatively in the case of ligament reconstruction, [12][13][14]43,44,54 to reproduce the anatomy as close as possible to the biomechanical values described in this study.…”

Section: Discussionmentioning

confidence: 99%

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A Preliminary Study to Assess the Relevance of Shear-Wave Elastography in Characterizing Biomechanical Changes in the Deltoid Ligament Complex in Relation to Ankle Position

et al. 2022

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Background: The purpose of this study was (1) to evaluate the biomechanical properties of the different bundles of the deltoid ligament in various ankle positions in a cohort of healthy adult volunteers; (2) describe the impact of demographic and hindfoot morphology characteristics on their stiffness; (3) to assess the reliability and reproducibility of these measurements. Methods: Deltoid ligament complex of both ankles were assessed by shear-wave elastography (SWE) in 20 healthy patients resting on hinge support. The propagation shear-wave speed (SWS) in ligaments was measured, which is related to the tissue’s elastic modulus. The following ligaments were analyzed in a neutral position and then in varus, valgus, dorsal, and plantar flexions: tibionavicular ligament (TNL), tibiocalcaneal ligament (TCL), the superficial posterior tibiotalar ligament (SPTL), the anterior tibiotalar ligament (ATTL), and the deep posterior tibiotalar ligament (DPTTL). Results: The mean SWS increased between neutral and 20 degrees valgus position for TCL (4.08 ± 0.78 m/s vs 5.56 ± 0.62 m/s, respectively; P < .0001) and for DPTTL (2.58 ± 0.52 m/s vs 3.59 ± 0.87 m/s, respectively; P < .0001). The mean SWS increased between neutral and 30 degrees plantarflexion for ATTL (2.11 ± 0.44 m/s vs 3.1 ± 0.5 m/s, respectively; P < .0001) and TNL (2.96 ± 0.66 m/s vs 4.99 ± 0.69 m/s, respectively; P < .0001). The mean SWS increased between neutral and 20 degrees dorsal flexion for SPTL (4.2 ± 1 m/s vs 5.45 ± 0.65 m/s, respectively; P < .0001). Women had less DPTTL SWS than men in the neutral position (2.37 ± 0.35 m/s vs 2.71 ± 0.49 m/s, respectively; P = .007). Other demographics had no impact on the SWS value of other ligaments. All inter- and intraobserver agreements were good to excellent. Conclusion: This study presents a reliable and reproducible SWE measurement protocol to describe the physiological function of all bundles of the medial collateral ligament in healthy adults. Clinical relevance: This examination technique can be available to orthopaedic surgeons, allowing reliable and reproducible monitoring of the SWS of the various ligaments constituting the medial collateral plane. The biomechanical values described in this study may give insight into in what position medial ankle ligament reconstruction should be tensioned.

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Medial Deltoid Ligament Injuries

Mansur

Auch

Schmidt

2022

Tendon and Ligament Injuries of the Foot and Ankle

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Indications for Deltoid and Spring Ligament Reconstruction in Progressive Collapsing Foot Deformity

Cited by 30 publications

References 31 publications

Intra- and Interobserver Reliability of the New Classification System of Progressive Collapsing Foot Deformity

Intra- and Interobserver Reliability of the New Classification System of Progressive Collapsing Foot Deformity

A Preliminary Study to Assess the Relevance of Shear-Wave Elastography in Characterizing Biomechanical Changes in the Deltoid Ligament Complex in Relation to Ankle Position

Medial Deltoid Ligament Injuries

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