Spring and Deltoid Ligament Insufficiency in the Setting of Progressive Collapsing Foot Deformity. An Update on Diagnosis and Management

Krautmann, Kurt; Kadakia, Anish R.

doi:10.1016/j.fcl.2021.05.004

Cited by 13 publications

(4 citation statements)

References 55 publications

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“…It has been suggested that further division of the TCNL is not anatomically or functionally useful because of the close relationship of these structures, and these anatomic considerations have affected how treatment for flatfoot is approached. 9,16,41,48…”

Section: Spring Ligament Anatomy and Functionmentioning

confidence: 99%

“…In addition to or independent from posterior tibial tendon (PTT) dysfunction, PCFD occurs with loss of ligamentous support across the hindfoot and midfoot. 22,41…”

Section: Introductionmentioning

confidence: 99%

“…In addition to or independent from posterior tibial tendon (PTT) dysfunction, PCFD occurs with loss of ligamentous support across the hindfoot and midfoot. 22,41 Surgery for PCFD usually includes a combination of osseous realignment and soft tissue reconstruction, predominantly of the PTT via tendon transfers. Realignment may be through osteotomy or fusion, and each procedure has its own risks and benefits.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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Section: Spring Ligament Anatomy and Functionmentioning

confidence: 99%

“…In addition to or independent from posterior tibial tendon (PTT) dysfunction, PCFD occurs with loss of ligamentous support across the hindfoot and midfoot. 22,41…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Spring Ligament Reconstruction for Progressive Collapsing Foot Deformity: Contemporary Review

2023

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“…[11,12] It is generally agreed that medial malleolus fracture and deltoid ligament rupture could not occur simultaneously. [13][14][15] It is sometimes possible that an anteromedial malleolus avulsion fracture could be accompanied by a deltoid ligament injury. [16] This study reported a failed case of a 36 year-old man diagnosed with trimalleolar fracture accompanying ankle dislocation initially.…”

Section: Introductionmentioning

confidence: 99%

Could medial malleolus fracture be combined with deltoid ligament injury?: A rare case report

Li,

Liu,

Dong

2024

Medicine

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Rationale: Medial malleolus injuries mainly comprise of fractures and deltoid ligament ruptures. Medial malleolus fractures, as a kind of common ankle fractures, could occur separately or be accompanied by lateral and posterior malleolus fractures. It is generally agreed that medial malleolus fracture and deltoid ligament rupture could not occur simultaneously. Patient concerns: In our study, we report a case of 36 year-old man diagnosed with trimalleolar fracture accompanying ankle dislocation initially. The patient was admitted to our hospital due to traffic accident. Diagnosis: The patient was diagnosed with trimalleolar fracture accompanying ankle dislocation initially. We missed the diagnosis of accompanied deltoid ligament due to the arthralgia of medial ankle and the widened medial articular space in X-ray after operation. Intervention: As we missed the diagnosis of accompanied deltoid ligament, we only selected open reduction and internal fixation for trimalleolar fracture at first. After we realized the existence of deltoid ligament rupture, the patient refuse further diagnosis and treatment in our hospital. Outcomes: During the rehabilitation exercise, the patient had medial arthralgia in his right ankle. He complained it and refuse further diagnosis and treatment in our hospital. Lessons: The newfound injury pattern, medial malleolus fracture accompanying deltoid ligament rupture, has not been reported in previous studies. The injury pattern needs further researches to explore the mechanism and it should be taken seriously in clinical practice.

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Deltoid ligament injuries: When and how to repair

Seiça,

Mendes,

Sousa

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThis study aims to illustrate the assessment and treatment strategies of acute and chronic deltoid ligament injuries, providing a treatment algorithm for each scenario.MethodsA retrospective review was conducted on 39 patients, who had either an acute deltoid ligament injury or suffered chronic deltoid ligament insufficiency. All patients were operated on between January 2016 and December 2022. The cases represent a range of different clinical scenarios, including acute trauma, chronic insufficiency or instability situations. Clinical and imaging evaluation, surgical techniques and clinical outcomes are presented.ResultsThe mean follow‐up time was 21.3 months (±4.5). Acute trauma represented 18 (46%) of the ankles, while 21 (54%) had chronic instability. Treatment options were tailored according to the aetiology, patient characteristics, injury pattern and associated lesions. In 11 of the 18 acute deltoid ruptures (64%), repair was performed using suture anchors, while the remaining 7 cases were treated with direct suture. In chronic deltoid insufficiency, re‐tensioning with suture anchor was performed in 14 (67%) ankles, suture imbrication in 5 (24%) and reconstruction in 6 (9%). The most common associated injuries were syndesmotic injuries (n = 12, 56%) and osteochondral lesions (n = 13, 36%). The complication rate was 18% (n = 7), the majority related to persistent stiffness (n = 4, 10%).ConclusionThe decision on when and how to repair the deltoid ligament should be guided by the characteristics of the injury and the individual patient. The current treatment rationale may serve as a working basis for evaluating and treating these ankles.Level of EvidenceLevel IV.

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Spring and Deltoid Ligament Insufficiency in the Setting of Progressive Collapsing Foot Deformity. An Update on Diagnosis and Management

Cited by 13 publications

References 55 publications

Spring Ligament Reconstruction for Progressive Collapsing Foot Deformity: Contemporary Review

Spring Ligament Reconstruction for Progressive Collapsing Foot Deformity: Contemporary Review

Could medial malleolus fracture be combined with deltoid ligament injury?: A rare case report

Deltoid ligament injuries: When and how to repair

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