Spring ligament tear decreases static stability of the ankle joint

Kelly, Meghan; Masqoodi, Noorullah; Vasconcellos, Daniel; Fowler, Xavier; Osman, Walid; Elfar, John C.; Olles, Mark; Ketz, John; Flemister, Adolph S.; Oh, Irvin

doi:10.1016/j.clinbiomech.2018.11.011

Cited by 17 publications

(17 citation statements)

References 19 publications

(27 reference statements)

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“…A large spring ligament tear leads to further progression of medial instability and deltoid dysfunction that affects the tibiotalar joint. 14 This is supported by a biomechanical study that demonstrated that a large spring ligament tear led to decreased static stability of the ankle joint. 14 Previous anatomic studies have demonstrated that the superomedial spring ligament blends with the superficial deltoid ligament, forming a larger medial ligament complex, the tibiocalcaneonavicular ligament (TCNL), which provides medial peritalar stability to the talonavicular, subtalar, and tibiotalar joints.…”

Section: Introductionmentioning

confidence: 84%

“…14 This is supported by a biomechanical study that demonstrated that a large spring ligament tear led to decreased static stability of the ankle joint. 14 Previous anatomic studies have demonstrated that the superomedial spring ligament blends with the superficial deltoid ligament, forming a larger medial ligament complex, the tibiocalcaneonavicular ligament (TCNL), which provides medial peritalar stability to the talonavicular, subtalar, and tibiotalar joints. 3,5 The importance of restoring peritalar stability in surgical treatment for advanced stages of AAFD has been suggested.…”

Section: Introductionmentioning

confidence: 84%

“…This finding supports the previous anatomic and biomechanical studies to suggest that the spring ligament complex significantly contributes to medial ankle stability. 2,3,5,14…”

Section: Discussionmentioning

confidence: 99%

“…Based on the anatomic characteristic of the TCNL and the findings in the biomechanical study performed by Baxter et al, we developed a 2-limb (tibionavicular and tibiocalcaneal) anatomic reconstruction of TCNL. 1,2,9 A biomechanical study performed by Kelly et al 14 tested the TCNL reconstruction in their cadaveric flatfoot model, which demonstrated a significantly diminished tibiotalar static joint reaction force (29%) associated with spring ligament injury (1.5 cm). They noted subsequent restoration of the tibiotalar and talonavicular joint reaction force associated with the tibionavicular limb reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…The concept of peritalar instability has increasingly gained interest. 2,4,7,11,14,18 Colin et al 4 described a case series of 4 patients with unstable valgus ankle deformities and stage IV AAFD. The authors noted progressive instability of the hindfoot and severe flattening of the arch after performing isolated tibiotalar fusion to correct an unstable ankle.…”

Section: Discussionmentioning

confidence: 99%

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Peritalar Kinematics With Combined Deltoid-Spring Ligament Reconstruction in Simulated Advanced Adult Acquired Flatfoot Deformity

et al. 2020

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Background: Adult acquired flatfoot deformity (AAFD) is a complex and progressive deformity involving the ligamentous structures of the medial peritalar joints. Recent anatomic studies demonstrated that the spring and deltoid ligaments form a greater medial ligament complex, the tibiocalcaneonavicular ligament (TCNL), which provides medial stability to the talonavicular, subtalar, and tibiotalar joints. The aim of this study was to assess the biomechanical effect of a spring ligament tear on the peritalar stability. The secondary aim was to assess the effect of TCNL reconstruction in restoration of peritalar stability in comparison with other medial stabilization procedures, anatomic spring or deltoid ligament reconstructions, in a cadaveric flatfoot model. Methods: Ten fresh-frozen cadaveric foot specimens were used. Reflective markers were mounted on the tibia, talus, navicular, calcaneus, and first metatarsal. Peritalar joint kinematics were captured by a multiple-camera motion capture system. Mild, moderate, and severe flatfoot models were created by sequential sectioning of medial capsuloligament complex followed by cyclic axial loading. Spring only, deltoid only, and combined deltoid-spring ligament (TCNL) reconstructions were performed. The relative kinematic changes were compared using 2-way analysis of variance (ANOVA). Results: Compared with the initial condition, we noted significantly increased valgus alignment of the subtalar joint of 5.1 ± 2.3 degrees ( P = .031) and 5.8 ± 2.7 degrees ( P < .01) with increased size of the spring ligament tear to create moderate to severe flatfoot, respectively. We noted an increased tibiotalar valgus angle of 5.1 ± 2.0 degrees ( P = .03) in the severe model. Although all medial ligament reconstruction methods were able to correct forefoot abduction, the TCNL reconstruction was able to correct both the subtalar and tibiotalar valgus deformity ( P = .04 and P = .02, respectively). Conclusion: The TCNL complex provided stability to the talonavicular, subtalar, and tibiotalar joints. The combined deltoid-spring ligament (TCNL) reconstructions restored peritalar kinematics better than isolated spring or deltoid ligament reconstruction in the severe AAFD model. Clinical Relevance: The combined deltoid-spring ligament (TCNL) reconstruction maybe considered in advanced AAFD with medial peritalar instability: stage IIB with a large spring ligament tear or stage IV.

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Section: Introductionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 84%

“…This finding supports the previous anatomic and biomechanical studies to suggest that the spring ligament complex significantly contributes to medial ankle stability. 2,3,5,14…”

Section: Discussionmentioning

confidence: 99%