Anatomic Reconstruction Technique for a Plantar Calcaneonavicular (Spring) Ligament Tear

2015 ◽  
Vol 54 (6) ◽  
pp. 1124-1126 ◽  
Author(s):  
Ezequiel Palmanovich ◽  
Shay Shabat ◽  
Yaron S. Brin ◽  
Viktor Feldman ◽  
Benny Kish ◽  
...  
Keyword(s):  
Anatomic Reconstruction ◽  
Reconstruction Technique ◽  
Ligament Tear ◽  
Spring Ligament

scholarly journals Tibiocalcaneonavicular Ligament Reconstruction in Simulated Flatfoot Deformity with Medial Ligament Insufficiency

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0032
Author(s):  
Ashlee MacDonald ◽  
David Ciufo ◽  
Emma Knapp ◽  
Hani Awad ◽  
John Ketz ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Reaction Force ◽  
Abduction Angle ◽  
Deltoid Ligament ◽  
Reconstruction Technique ◽  
Advanced Stage ◽  
Interosseous Ligament ◽  
Ligament Tear ◽  
Spring Ligament ◽  
Bone Tunnels

Category: Hindfoot Introduction/Purpose: Spring ligament tear is often present in advanced stages of the AAFD. Anatomic studies have demonstrated that the superficial deltoid ligament blends with the superomedial spring ligament to provide medial tibiotalar and talonavicular stability. Reconstruction of combined deltoid-spring ligament, or the Tibiocalcaneonvaicular ligament (TCNL) was proposed to augment medial stability in advanced AAFD with large spring ligament tears. A tendon allograft is placed to cross three peritalar (tibiotalar, talonavicular and subtalar) joints to augment medial stability. We aimed to 1) investigate the kinematic effects of TCNL reconstruction in cadaveric flatfoot model with medial ligament insufficiency, and 2) compare TCNL reconstruction with anatomic spring and anatomic deltoid ligament reconstructions (Figure 1). We hypothesized that TCNL reconstruction is effective in restoring peritalar kinematics. Methods: Five fresh-frozen cadaveric foot specimens were employed. Advanced stage flatfoot model was created by sectioning the medial and inferior talonavicular interosseous ligament and extending the release 2 cm proximally along the superomedial spring ligament. Cyclic axial load of 1150 N under a hydraulic loading frame with constant 350 N Achilles tendon load were applied until >15° talo-first metatarsal abduction was achieved. Bone tunnels were drilled for three reconstruction types, and the peroneus longus tendon was configured to reconstruct the 1) anatomic spring ligament, 2) anatomic deltoid ligament, and 3) TCNL. Reflective markers were mounted on the tibia, talus, navicula, calcaneus and first metatarsus. Each reconstruction type was loaded with 800 N ground reaction force, and kinematics of the peritalar joints were captured by 4-camera motion capture system. Forefoot abduction angle, Meary’s angle, and hindfoot valgus were calculated and compared to the severe flatfoot prior to reconstruction and to each using two-way ANOVA. Results: In creating the flatfoot deformity, both the tibiotalar and subtalar joints demonstrated an increase in valgus deformity by 5.6+3.7° and 6.1+5.3°, respectively, compared to the initial measurements. When comparing to the flatfoot deformity, the TCNL reconstruction achieved a significant improvement in percent correction of total hindfoot valgus (59.7+21.1%, p=0.017) and forefoot abduction angle (83.4+17.7%, p<0.01). The spring ligament reconstruction also demonstrated a significant improvement in forefoot abduction correction compared to the flatfoot (52+10.6%, p<0.05). No other reconstruction technique achieved a statistically significant improvement in percent correction compared to the flatfoot model in forefoot or hindfoot alignments. Additionally, no statistical differences were noted in the percent correction when comparing the three reconstructive techniques to each other. Conclusion: In advanced stage cadaveric flatfoot with spring ligament tear, we found increased valgus alignment at both the tibiotalar and subtalar joints. This kinematic changes reflects increased strain across the medial peritalar ligaments. The deltoid-spring ligament complex (TCNL) reconstruction demonstrated significantly improved alignment of hindfoot valgus and forefoot abduction compared to the severe flatfoot condition. This finding suggests that in addition to osseous correction and tendon transfer, the TCNL reconstruction may serve as an important component in augmenting medial stability in advanced AAFD with medial ligament insufficiency.

Novel reconstruction technique for an isolated plantar calcaneonavicular (SPRING) ligament tear

The Foot ◽  
2017 ◽  
Vol 30 ◽  
pp. 1-4 ◽  
Author(s):  
Ezequiel Palmanovich ◽  
Shay Shabat ◽  
Yaron S. Brin ◽  
Sabri Massrawe ◽  
Iftach Hestroni ◽  
...  
Keyword(s):  
Reconstruction Technique ◽  
Ligament Tear ◽  
Spring Ligament

scholarly journals Revision ACL Reconstruction in Adolescent Patients

2020 ◽  
Vol 8 (9) ◽  
pp. 232596712095333
Author(s):  
Caitlin M. Rugg ◽  
Austin A. Pitcher ◽  
Christina Allen ◽  
Nirav K. Pandya
Keyword(s):  
Graft Failure ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Case Series ◽  
Anatomic Reconstruction ◽  
Reconstruction Technique ◽  
Level Of Evidence ◽  
Adult Type ◽  
Adolescent Patients ◽  
Graft Diameter

Background: High failure rates have been documented after anterior cruciate ligament reconstruction (ACLR) in pediatric patients, and revision surgery is indicated due to high activity levels of children and adolescents. Purpose: To define trends in revision ACLR in patients who underwent initial ACLR at younger than 18 years. Study Design: Case series; Level of evidence, 4. Methods: An electronic medical record was used to retrospectively identify revision ACLR procedures performed by 2 surgeons between the years 2010 and 2016 in patients younger than 18 years at initial reconstruction. Descriptive information, intraoperative findings, surgical techniques, and rehabilitation data were recorded from initial and revision surgeries. Descriptive statistics were used. Results: A total of 32 patients (17 girls, 15 boys) met the inclusion criteria, with a mean age of 15.8 years at initial reconstruction. For initial reconstructions, 15 patients underwent transphyseal procedures, 3 patients underwent adult-type procedures using an anatomic reconstruction technique that did not take into account the physis, and 2 patients underwent partial intraepiphyseal procedures. Graft types included hamstring autograft (n = 17), allograft (n = 5), hybrid (n = 4), and bone–patellar tendon–bone autograft (BTB; n = 3). Average primary reconstruction graft diameter was 8.0 mm (girls, 7.72 mm; boys, 8.36 mm; P = .045). After initial reconstruction, 10 patients had postoperative protocol noncompliance, and 8 patients reported delayed recovery. Mean time to retear was 565 days (range, 25-1539 days). At revision, BTB autograft was used in 50% (n = 16), followed by hamstring autograph (31.3%; n = 10) and allograft (12.5%; n = 4); mean graft diameter was 9.05 mm. Chondral surgery was more common during revision (25% for revision vs 0% for index; P = .031). There were 4 patients who required staged reconstruction with bone grafting. At mean final follow-up of 29.5 months (SD, 22.2 months), there were 3 graft failures (9.4%) and 5 contralateral ACL ruptures (15.6%). Conclusion: Most patients with ACL graft failure were adequately treated with a single revision. Conversion from a soft tissue graft to a BTB autograft was the most common procedure. Infrequently, patients required staged reconstructions. Providers should have a high index of suspicion for associated intra-articular injuries resulting from graft failure in adolescent patients.

scholarly journals Arthroscopic Popliteus sling Reconstruction using the ‘Popliteus portal’ : An effective way to restore the Posterolateral corner stability A Case Series and Surgical Technique

2019 ◽  
Author(s):  
Abey Thomas Babu ◽  
Santosh Sahanand ◽  
David Rajan
Keyword(s):  
Surgical Technique ◽  
Clinical Outcomes ◽  
Case Series ◽  
Posterolateral Corner ◽  
Anatomic Reconstruction ◽  
Ligament Injury ◽  
Reconstruction Technique ◽  
Popliteus Tendon ◽  
Collateral Ligament ◽  
Fibular Collateral Ligament

Abstract Background: Posterolateral corner injuries can result in persistent varus and rotary instability. Many open/ arthroscopic procedures of reconstruction/ repair have been reported, but there is a paucity of literature on clinical outcomes. We follow an all arthroscopic reconstruction technique of the popliteus sling with the use of the ‘popliteus portal’ in cases of isolated popliteus injuries (intact fibular collateral ligament). Methodds: Prospective case study of 12 patients undergoing Arthroscopic Popliteus sling reconstruction with or without associated cruciate ligament reconstruction was peformed. We report our surgical technique and clinical outcomes. Results: All our patients had good to excellent knee function at final follow up (IKDC and Tegner Scores). We did not encounter any major complications intra or post – operatively. Conclusions: In cases of Popliteus tendon injury without fibular collateral ligament injury, an ‘all – arthroscopic’ Popliteus sling reconstruction is an effective and reproducible technique of restoring posterolateral stability of the knee. The advantages of our procedure are – an ‘all – arthroscopic Technique’, avoiding damage to the meniscotibial ligaments and a more ‘anatomic’ reconstruction of the popliteus sling. Keywords: Knee, Posterolateral corner injury, popliteus, Arthroscopy, Reconstruction

scholarly journals The Posterolateral Corner: Explanations and Outcomes

2021 ◽  
Vol 2 ◽  
pp. 108-118
Author(s):  
Robert F. LaPrade ◽  
Edward R. Floyd ◽  
Gregory B. Carlson ◽  
Gilbert Moatshe ◽  
Jorge Chahla ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Posterolateral Corner ◽  
Anatomic Reconstruction ◽  
Reconstruction Technique ◽  
Resonance Imaging ◽  
Rehabilitation Protocol ◽  
Reconstruction Methods ◽  
Rehabilitation Protocols ◽  
Objective Outcomes

In this review, we examine the current understanding of posterolateral corner (PLC) injuries and treatment methods. We discuss the anatomy of the major structures of the PLC and the biomechanics of how these structures function together as a unit. The diagnosis using physical examination, radiographs, and magnetic resonance imaging is discussed. The development of an anatomic reconstruction technique is then described, along with the surgical technique and rehabilitation protocols. Anatomic-based reconstruction methods and a regimented rehabilitation protocol better restore the native biomechanics of the knee, and improve subjective and objective outcomes at follow-up.

scholarly journals The Popliteus Bypass Graft is biomechanically superior to the isometric Larson Technique for posterolateral instabilities of the knee

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0002
Author(s):  
Tobias C. Drenck ◽  
Christoph Domnick ◽  
Achim Preiss ◽  
Karl-Heinz Frosch ◽  
Mathias von Glahn
Keyword(s):  
External Rotation ◽  
Tracking System ◽  
Cruciate Ligament ◽  
Bypass Graft ◽  
Optical Tracking ◽  
Anatomic Reconstruction ◽  
Rotational Instability ◽  
Reconstruction Technique ◽  
Group A ◽  
Group B

Injuries of the posterior cruciate ligament (PCL) are most often accompanied by injuries of the posterolateral corner (PLC) and the ligamentum collaterale fibulare (LCL). This leads to a combined dorsal- and external rotational instability. In Germany most of these types of injuries are treated by an arthroscopic reconstruction of the PCL and combined posterolateral augmentation in the way, of an isometric “Larson-Procedure”. Techniques, which reconstruct the LCL and PLC in a more anatomic way provide better clinical results according to current literature. Comparative studies of these two types of reconstructions do not exist, biomechanical studies are inhomogeneous and the isometric Larson-technique has not been adequately tested so far. In this study the isometric (extra anatomic) Larson-technique was tested against a more anatomic reconstruction of the LCL and PLC with a popliteus bypass graft. 20 human knee specimen were divided into Group A and B. The PCL, as well as the PLC and LCL were dissected and kinematic measurements were determined using a robotic and optical tracking system. The knee kinematics were determined for 134 N posterior loads, 10 Nm varus loads and 5 Nm external rotational loads in 0°, 20°, 30°, 60° and 90° of knee flexion. All specimens underwent a double bundle PCL reconstruction. In Group A the reconstruction of the PLC was accomplished by a popliteus bypass graft and an additional anatomic LCL graft. In Group B the reconstruction was performed using a Larson-technique with a single femoral tunnel and a sling through the head of the fibular. The protocol was repeated and the differences in the two groups where analyzed (2W-Anova and t-Test, p=0,05) Both groups gained a significant increase of instability after dissecting the ligamentous structures (deficient) in all algorithms tested. Postoperatively both groups achieved a significant improvement in all these parameters. Group A with the popliteus bypass technique revealed significant 37±8% less external rotational instability compared to group B (p<0,03). In contrast to group A, group B presents a remaining increase of external rotation compared to the intact knee. The popliteus bypass in group A reduced the external rotational instability to less than 1,3 degree difference compared to the intact state on average. No significant results were found between the two groups in terms of varus instability and posterior loads. In this study we showed for the first time, that the most frequently used posterolateral reconstruction technique (isometric Larson) has limited biomechanical properties compared to a more anatomic reconstruction (popliteus bypass) in terms of reducing external rotation. Whether this is the cause of the remaining posterolateral instability in patients treated with the Larson technique and whether it can be prevented by using a popliteus bypass graft is subject of future clinical studies.

652: Anatomical Foundations of the Anatomic Reconstruction Technique of Continence

2007 ◽  
Vol 177 (4S) ◽  
pp. 219-219
Author(s):  
Sandhya Rao ◽  
Atsushi Takenaka ◽  
Juan Salamanca ◽  
Moshim Kukar ◽  
Rajan Ramanathan ◽  
...  
Keyword(s):  
Anatomic Reconstruction ◽  
Reconstruction Technique

Biomechanical Comparison of Anatomic Restoration of the Ulnar Footprint vs Traditional Ulnar Tunnels in Ulnar Collateral Ligament Reconstruction

2021 ◽  
pp. 036354652110544
Author(s):  
Edward S. Chang ◽  
Anthony H. Le ◽  
Austin M. Looney ◽  
MAJ Donald F. Colantonio ◽  
CPT William B. Roach ◽  
...  
Keyword(s):  
Ulnar Collateral Ligament ◽  
Anatomic Reconstruction ◽  
Reconstruction Technique ◽  
Collateral Ligament ◽  
Time Zero ◽  
Initial Fixation ◽  
Valgus Angle ◽  
Starting Point ◽  
Bone Tunnels

Background: Current techniques for ulnar collateral ligament (UCL) reconstruction do not reproduce the anatomic ulnar footprint of the UCL. The purpose of this study was to describe a novel UCL reconstruction technique that utilizes proximal-to-distal ulnar bone tunnels to better re-create the anatomy of the UCL and to compare the biomechanical profile at time zero among this technique, the native UCL, and the traditional docking technique. Hypothesis: The biomechanical profile of the anatomic technique is similar to the native UCL and traditional docking technique. Study Design: Controlled laboratory study. Methods: Ten matched cadaveric elbows were potted with the forearm in neutral rotation. The palmaris longus tendon graft was harvested, and bones were sectioned 14 cm proximal and distal to the elbow joint. Specimen testing included (1) native UCL testing performed at 90° of flexion with 0.5 N·m of valgus moment preload, (2) cyclic loading from 0.5 to 5 N·m of valgus moment for 1000 cycles at 1 Hz, and (3) load to failure at 0.2 mm/s. Elbows then underwent UCL reconstruction with 1 elbow of each pair receiving the classic docking technique using either anatomic (proximal to distal) or traditional (anterior to posterior) tunnel locations. Specimen testing was then repeated as described. Results: There were no differences in maximum load at failure between the anatomic and traditional tunnel location techniques (mean ± SD, 34.90 ± 10.65 vs 37.28 ± 14.26 N·m; P = .644) or when including the native UCL (45.83 ± 17.03 N·m; P = .099). Additionally, there were no differences in valgus angle after 1000 cycles across the anatomic technique (4.58°± 1.47°), traditional technique (4.08°± 1.28°), and native UCL (4.07°± 1.99°). The anatomic group and the native UCL had similar valgus angles at failure (24.13°± 5.86° vs 20.13°± 5.70°; P = .083), while the traditional group had a higher valgus angle at failure when compared with the native UCL (24.88°± 6.18° vs 19.44°± 5.86°; P = .015). Conclusion: In this cadaveric model, UCL reconstruction with the docking technique utilizing proximal-to-distal ulnar tunnels better restored the ulnar footprint while providing valgus stability comparable with reconstruction with the docking technique using traditional anterior-to-posterior ulnar tunnel locations. These results suggest that utilization of the anatomic tunnel location in UCL reconstruction has similar biomechanical properties to the traditional method at the time of initial fixation (ie, not accounting for healing after reconstruction in vivo) while keeping the ulnar tunnels farther from the ulnar nerve. Further studies are warranted to determine if an anatomically based UCL reconstruction results in differing outcomes than traditional reconstruction techniques. Clinical Relevance: Current UCL reconstruction techniques do not accurately re-create the ulnar UCL footprint. The UCL is a dynamic constraint to valgus loads at the elbow, and a more anatomic reconstruction may afford more natural joint kinematics. This more anatomic technique performs similarly to the traditional docking technique at time zero, and the results of this study may offer a starting point for future in vivo studies.

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