Novel Reconstruction of a Static Medial Ligamentous Complex in a Flatfoot Model

Abstract

The surgical technique evaluated here may be useful as a new soft tissue reconstructive procedure for treating adult flatfoot.

Reconstruction of the Medial Talonavicular Joint in Simulated Flatfoot Deformity

“…We found that reconstructing the soft tissues of the medial arch (Figures 1B and 1C) provide excellent correction of the midfoot deformity, which agrees with previous investigations by Choi et al 6 and Tan et al 27 Furthermore, tibio-navicular reconstruction corrected the midfoot eversion deformity, which compares similarly to a reconstruction of the of the deltoid complex. 19 There was a graded effect between deformity correction and proximal fixation of the reconstruction.…”

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

“…1,4,5,8 Lateral column lengthening and fusions do not re-create normal foot kinematics, and many report reduced subjective and objective outcomes. 1,11,15,20,23,[34][35][36] Complication rates are higher 16,18,25,27,32,[39][40][41][42][43][44][45][46][47][48][49] and carry additional risks to joint-preserving procedures such as nonunion, avascular necrosis, and increased incidence of secondary arthritis. 33,34,42 Subsequently, joint preservation surgery has become increasingly explored.…”

“…The technique used was a modification of a method using semitendinosus allograft. 21,40 The patient was positioned supine with an above-knee tourniquet. If required, a medial head of gastrocnemius recession and medializing calcaneal osteotomy were performed.…”

“…In addition, they also describe multiple different tendon augments, including Achilles tendon allograft, hamstring allograft, split tibialis anterior transfer, and peroneus longus transfer, among others. 3,10,40,43 Rarely are any of these soft tissue reconstructions performed in isolation. Bony procedures such as a medial displacing calcaneal osteotomy, rotational (Z) osteotomy, or lateral column lengthening are used to protect soft tissue procedures or add power to their correction.…”

Valgus Malalignment: What Joints to Address?

“…In the setting of a flexible deformity, as the medial column is corrected and stabilized, the lateral column is "pulled" distally by the correction (Figure 3). Stabilization of the N-C joint can be performed with an arthrodesis or, as biomechanically demonstrated by Tan and Kadakia et al, 4 a medial ligamentous reconstruction can be performed. This allows correction of the deformity without the need for an arthrodesis (Figure 4).…”