Reconstruction of superficial deltoid ligaments with allograft tendons in medial ankle instability: A technical report

Jung, Hong-Geun; Park, Jong-Tae; Eom, Jin Sup; Jung, Myung Gon; Lee, DongOh

doi:10.1016/j.injury.2016.01.009

Cited by 14 publications

(6 citation statements)

References 16 publications

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“…In the CSPLR technique, the graft passed from the distal attachment of the peroneus longus to the anterior calcaneal hole functions similar to other plantar structures, which have a longer momentum arm compared to the spring ligaments to support the medial arch. Furthermore, in the CSILR technique, the graft extended from the hole in the navicular to the tibia could function as the tibionavicular ligament, which could restrain the talonavicular joint medial subluxation and forefoot abduction [49, 50]. Therefore, the importance of the superficial deltoid ligament, plantar fascia, and other plantar structures should be included in the reconstructive plan.…”

Section: Discussionmentioning

confidence: 99%

Nonanatomic versus anatomic techniques in spring ligament reconstruction: biomechanical assessment via a finite element model

Wang

et al. 2019

J Orthop Surg Res

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Background Several approaches to spring ligament reconstruction have been reported. However, a comparative study of nonanatomic and anatomic techniques with respect to biomechanical responses, such as kinematics and contact characteristics, has not been previously performed via a finite element analysis. The purpose of this study was to evaluate the biomechanical results of such spring ligament reconstructions via a finite element analysis. Methods A three-dimensional finite element model of the foot was developed and validated, and four reconstruction methods were simulated. The talonavicular dorsiflexion and abduction, hindfoot valgus, and contact characteristics in the Chopart joints were quantified in each model. Results Nonanatomic reconstructions corrected the talonavicular and hindfoot deformities to a greater extent than the anatomic reconstructions. The anatomic techniques also corrected the abduction and dorsiflexion deformities, although they presented insufficient power to correct for hindfoot valgus. None of the procedures restored the contact characteristics of the talonavicular and calcaneocuboid joints to those of a normal condition. Conclusion Nonanatomic reconstruction of the spring ligament complex provided the greatest correction for midfoot and hindfoot misalignments in flatfoot. Severe deformities with large amounts of midfoot pronation and hindfoot valgus may be better treated with nonanatomic reconstruction methods. The spring ligament reconstruction method may mitigate the need for nonanatomic bony procedures associated with complications and allows for the preservation of the triple joint complex.

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Section: Discussionmentioning

confidence: 99%

Nonanatomic versus anatomic techniques in spring ligament reconstruction: biomechanical assessment via a finite element model

Wang

et al. 2019

J Orthop Surg Res

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“…Some surgeons may oppose direct repair of the deltoid ligament in a chronic scenario because of compromised tissue quality. Deltoid ligament reconstruction techniques have been described using the peroneal longus or allograft tendons (12,13). Deland et al describe deltoid ligament reconstruction with peroneus longus tendon.…”

Section: Discussionmentioning

confidence: 99%

“…There remains some controversy over the surgical indications for repair and how best to repair the deltoid ligament complex. There have been multiple techniques published previously with no technique shown to have superior outcomes (1,(10)(11)(12)(13). The available data suggests that in cases where the native deltoid ligament tissue is of good quality that a primary repair, with or without augmentation, is reasonable (2,10).…”

Section: Introductionmentioning

confidence: 99%

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Chronic medial ankle instability medial drive through sign and surgical repair technique

Gentile

Rigby

Fleming

et al. 2022

Foot & Ankle Surgery: Techniques, Reports & Cases

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“…Most of these injuries are associated with malleolus medialis fracture and wither joint impairment. Among patients suffering from disability of later shin tendon, joint fusion of ankle and ankle replacement we can also see independent impaired deltoid ligaments (2). …”

Section: Introductionmentioning

confidence: 99%

Analysis of 3-dimensional finite element after reconstruction of impaired ankle deltoid ligament

Xianzhong

et al. 2016

Experimental and Therapeutic Medicine

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We compared four repair techniques for impaired ankle ligament deltoideum, namely Wiltberger, Deland, Kitaoka and Hintermann using a 3-dimensional finite element. We built an ankle ligament deltoideum model, including six pieces of bone structures, gristles and main ligaments around the ankle. After testing the model, we built an impaired ligament deltoideum model plus four reconstruction models. Subsequently, different levels of force on ankles with different flexion were imposed and ankle biomechanics were compared. In the course of bending, from plantar flexion 20° to back flexion 20°, the extortion of talus decreased while the eversion increased. Four reconstruction models failed to bring back the impaired ankle to normal, with an obvious increase of extortion and eversion. The Kitaoka technique was useful to reduce the extortion angle in a consequential manner. Compared with the other three techniques, the Kitaoka technique produced better results for extortion angle and the difference was statistically significant. However, in case of eversion, there was no significant difference among the four techniques (P>0.05). Lateral ligament's stress in all the four models was different from the normal one. When the ankle was imposed with extortion moment of force, stress of anterior talofibular ligament with the Kitaoka reconstruction method was close to that of the complete deltoid ligament. When ankle was imposed with eversion moment of force, stress of anterior talofibular ligament with Kitaoka and Deland reconstruction methods were close to that of the complete deltoid ligament. We concluded that Kitaoka and Deland tendon reconstruction technique could recover impaired ankle deltoid ligament and re-established its normal biomechanics characteristics.

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Reconstruction of superficial deltoid ligaments with allograft tendons in medial ankle instability: A technical report

Cited by 14 publications

References 16 publications

Nonanatomic versus anatomic techniques in spring ligament reconstruction: biomechanical assessment via a finite element model

Nonanatomic versus anatomic techniques in spring ligament reconstruction: biomechanical assessment via a finite element model

Chronic medial ankle instability medial drive through sign and surgical repair technique

Analysis of 3-dimensional finite element after reconstruction of impaired ankle deltoid ligament

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