Combined Spring and Deltoid Ligament Repair in Adult-Acquired Flatfoot

2018 ◽  
Vol 39 (8) ◽  
pp. 903-907 ◽  
Author(s):  
Caio Nery ◽  
André Vitor Kerber C. Lemos ◽  
Fernando Raduan ◽  
Nacime Salomão B. Mansur ◽  
Daniel Baumfeld
Keyword(s):  
Case Series ◽  
Deltoid Ligament ◽  
Posterior Tibial Tendon ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Posterior Tibial ◽  
Novel Technique ◽  
Spring Ligament ◽  
Tissue Healing ◽  
Internal Brace

Background: Adult-acquired flatfoot deformity (AAFD) is usually due to a combination of mechanical failure of the osteoligamentous complex that maintains the medial longitudinal arch of the foot and attenuation or complete tear of the posterior tibial tendon. Magnetic resonance imaging studies in patients with flatfoot deformities have reported the posterior tibial tendon to be pathologic in up to 100% of patients, the spring ligament in up to 87%, and the deltoid ligament in 33%. Many studies in the literature describe reconstruction of the spring ligament or the deltoid ligament associated with AAFD, but there is no study in which both (spring and deltoid) ligaments are reconstructed at the same time. We describe a novel technique to reconstruct the deltoid ligament and the spring ligament at the same time. Methods: We described the technique and evaluated 10 consecutive patients with AAFD and insufficient ankle and midfoot ligaments. Results: We found no postoperative complications, stiffness, or loss of correction. Conclusion: We present a novel technique to reconstruct the failed deltoid and spring ligament during flatfoot correction. It is unique in that it uses internal brace augmentation with FiberTape® to help and protect the soft tissue healing. Level of Evidence: Level IV, retrospective case series.

scholarly journals Tendoscopic management of posterior tibial tendinitis

2020 ◽  
Vol 14 (2) ◽  
pp. 168-172
Author(s):  
Alberto Auellar-Avaroma ◽  
Ana Cristina King-Martinez
Keyword(s):  
Case Series ◽  
Posterior Tibial Tendon ◽  
Level Of Evidence ◽  
Posterior Tibial ◽  
Important Improvement ◽  
Number Of Patients ◽  
Patient Reported ◽  
Vas Scores ◽  
Cosmetic Outcomes

Objective: The aim of this study was to present a case series of patients undergoing posterior tibial tendoscopy, assess their clinical outcome, and describe surgical findings and treatment complications. Methods: This is a clinical, retrospective, observational study of 11 consecutive cases of tenosynovitis of the posterior tibial tendon. All 11 patients underwent tendoscopy of the posterior tibial tendon. All procedures were performed by the same surgeon in 2 different hospitals. Minimum follow-up was 2 years. Results: All patients had their preoperative and postoperative AOFAS and VAS scores assessed. Both scores had an important improvement at 12 months that persisted at 24 months. Moreover, 72.72% of the patients were very satisfied with the procedure, and no patient reported to be dissatisfied. Additionally, 90.91% of the patients had no postoperative complications. The present results are consistent with those previously reported in the literature. Conclusion: Endoscopic or tendoscopic repair of the posterior tibial tendon is a simple and reproducible procedure that provides good functional and cosmetic outcomes with a low complication rate. It is important to increase the number of patients in this series in order to expand our conclusions. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals A Novel Medial Malleolar Osteotomy Technique for the Treatment of Osteochondral Lesions of the Talus

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712198998
Author(s):  
Yong Hu ◽  
Cheng Yue ◽  
Xiucun Li ◽  
ZhengXun Li ◽  
Dongsheng Zhou ◽  
...  
Keyword(s):  
Case Series ◽  
High Rate ◽  
Osteochondral Lesions ◽  
Medial Malleolus ◽  
Posterior Tibial Tendon ◽  
The Novel ◽  
Level Of Evidence ◽  
Posterior Tibial ◽  
Medial Malleolar Osteotomy ◽  
Osteotomy Technique

Background: The current techniques for medial malleolar osteotomy may lead to posterior tibial tendon injury and have a high rate of malunion. Purpose: To describe a novel partial step-cut medial malleolar osteotomy technique and evaluate its technical feasibility and its advantages compared with traditional methods. Study Design: Case series; Level of evidence, 4. Methods: The novel technique consisted of osteotomy of the anterior one-third to two-thirds of the medial malleolus. A total of 19 ankles (18 patients) with osteochondral lesions of the talus underwent the novel osteotomy technique before osteochondral reconstruction. All patients were evaluated for more than 2 years. Radiographs were analyzed for postoperative displacement and malunion, and postoperative ankle function was evaluated according to the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale and the visual analog scale (VAS) for pain. Results: The partial step-cut osteotomy technique was able to provide adequate intra-articular exposure without disturbing the posterior tibial tendon. The 19 ankles healed at a mean of 7.3 ± 1.5 weeks (range, 6-12 weeks). There was slight incongruence in 4 ankles, with a displacement of 1.0 ± 0.1 mm proximally and 0.3 ± 0.1 mm medially. The mean postoperative AOFAS and VAS scores improved compared with preoperatively, from 54.2 ± 12.1 to 84.6 ± 6.6 and from 6.4 ± 1.0 to 1.8 ± 1.3, respectively ( P < .001 for both). No intraoperative tendon injuries were observed. Conclusion: Results indicated that partial step-cut osteotomy is a reliable and effective method for providing enough exposure, avoiding displacement after reduction, and not disturbing the anatomic structures behind the medial malleolus.

scholarly journals Assessment of imaging, pathoanatomy and terminology in posterior tibial tendon dysfunction

2020 ◽  
Vol 14 (2) ◽  
pp. 126-131
Author(s):  
Matthew Workman ◽  
Nick Saragas ◽  
Paulo Ferrao
Keyword(s):  
Case Series ◽  
Tendon Sheath ◽  
Pathological Process ◽  
Preoperative Imaging ◽  
Research Assessment ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Tendon Dysfunction ◽  
Mri Findings ◽  
Level Of Evidence ◽  
Posterior Tibial

Objective: This study aimed to determine damage/change occurring in the posterior tibial tendon of patients undergoing surgery for posterior tibial tendon dysfunction (PTTD) and to correlate preoperative imaging and intraoperative findings with histology to determine the most appropriate investigations for diagnosis. The secondary aim was to clarify terminology used in describing the tendon pathology, to improve descriptive terminology for research, assessment, and treatment of PTTD. Methods: The records of patients who had undergone surgery for stage 2 PTTD were retrospectively reviewed. Cases in which preoperative diagnostic imaging was done and a posterior tibial tendon specimen was sent for histology were included. Ultrasound (US) and MRI findings, surgical notes and histopathological reports were evaluated. Results: Nineteen patients met the inclusion criteria. Fourteen had US showing degenerative changes and synovitis. Five had MRI showing tendon degeneration, with rupture in two cases. Intraoperatively, all tendons showed gross abnormality, with surrounding synovitis. Microscopically, no acute inflammation was noted within any tendon specimens. All had non-specific reactive changes within the visceral synovium. Conclusion: This study confirms clear histological degeneration within the posterior tibial tendon of patients undergoing corrective surgery for PTTD. Preoperative imaging and surgical findings identified tendon sheath synovitis. Pre-operative ultrasound imaging and intraoperative confirmation of PTTD is accurate; thus, histological confirmation is unnecessary. The pathological changes in PTTD have been described as a tendinopathy in the literature. We suggest using the term pantendinopathy, which is a combination of peritendinitis with tendinosis, as it better describes the pathological process. Level of Evidence IV; Therapeutic Studies; Case Series

Adult Acquired Flatfoot Deformity at the Talonavicular Joint: Reconstruction of the Spring Ligament in an in Vitro Model

Foot & Ankle ◽  
1992 ◽  
Vol 13 (6) ◽  
pp. 327-332 ◽  
Author(s):  
Jonathan T. Deland ◽  
Stephen P. Arnoczky ◽  
Francesca M. Thompson
Keyword(s):  
Deltoid Ligament ◽  
Posterior Tibial Tendon ◽  
Joint Reconstruction ◽  
Posterior Tibial ◽  
Spring Ligament ◽  
Fresh Frozen ◽  
Adult Acquired Flatfoot Deformity ◽  
Vitro Model ◽  
Bone Autograft

The mobile unilateral flatfoot deformity of chronic posterior tibial tendon insufficiency has been difficult to correct by soft tissue procedures. The procedures can decrease pain, but they do not always correct the longitudinal arch or relieve all the symptoms. Using 10 fresh frozen cadaveric specimens and a rig for stimulation of weightbearing, the deformity associated with chronic posterior tibial tendon insufficiency was produced by multiple ligamentous release and documented by AP and lateral radiographs. Reconstruction of the spring ligament using a ligament bone autograft from the superficial deltoid ligament was then performed and tested under load. The mean correction was within 2.5° of normal (over or undercorrection) on both the AP and lateral radiographs with the specimens under load. Clinical Relevance. In posterior tibial tendon insufficiency, it may be possible to address the ligament as well as tendon insufficiency to gain a corrected arch. The success of such a procedure will depend upon adequate tendon and ligament reconstruction in a fully mobile deformity. Questions remain as to the adequacy of this ligament graft, and a stronger free ligament graft, as well as correction of any bony malalignment, may be required.

Prevalence of Abnormal Ultrasound Findings in Asymptomatic Posterior Tibial Tendons

2020 ◽  
Vol 41 (9) ◽  
pp. 1049-1055
Author(s):  
F. Baker Mills ◽  
Kevin Williams ◽  
Christopher H. Chu ◽  
Paul Bornemann ◽  
J. Benjamin Jackson
Keyword(s):  
Pathological Condition ◽  
Case Series ◽  
Institutional Review Board ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Tendon Dysfunction ◽  
Level Of Evidence ◽  
Posterior Tibial ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Ultrasound Findings

Background: Posterior tibial tendon dysfunction (PTTD) is a pathological condition that can cause failure of the posterior tibial tendon (PTT). Initially, patients with PTTD are often asymptomatic, making early identification and treatment challenging. Certain ultrasound (US) characteristics have been implicated in the presence of tendinopathy, but their frequency has yet to be assessed in the PTT. The purpose of this study was to identify and report on the frequency of incidental, or potentially early subclinical, tendinopathic US characteristics in asymptomatic PTTs. Methods: Following institutional review board approval, 150 participants underwent a bilateral-comprehensive US assessment. The resulting images were reviewed and assessed to identify the presence of abnormalities demonstrated to represent tendinopathy. Results: Overall, 266 tendons were assessed and 128 (48.1%) were determined to have at least one tendinopathic trait. Specifically, 51 (19.2%) had circumferential fluid, 69 (25.9%) had noncircumferential fluid, 22 (8.3%) had thickening, 31 (11.7%) had heterogenicity, 19 (7.1%) had hyperemia, and 2 (0.8%) had calcification. Additionally, Caucasian participants were found to be nearly 3 times more likely to have tendinopathic findings when compared with African American participants. Conclusion: Sixty-seven percent of participants and 48.1% of PTTs evaluated had at least one tendinopathic feature identified on US. The prevalence rates of these findings, observed in participants, were as follows: noncircumferential fluid, circumferential fluid, heterogenicity, and thickening. Knowing the frequency of these traits may help clinicians to identify subclinical tendinopathy in the PTT before it progresses to PTTD. Level of Evidence: Level IV, case series.

Ulnar Collateral Ligament Repair With Collagen-Dipped FiberTape Augmentation in Overhead-Throwing Athletes

2019 ◽  
Vol 47 (5) ◽  
pp. 1096-1102 ◽  
Author(s):  
Jeffrey R. Dugas ◽  
Christopher A. Looze ◽  
Brian Capogna ◽  
Brian L. Walters ◽  
Christopher M. Jones ◽  
...  
Keyword(s):  
Case Series ◽  
Ulnar Collateral Ligament ◽  
Return To Play ◽  
Final Decision ◽  
Collateral Ligament ◽  
Tissue Quality ◽  
Level Of Evidence ◽  
Overhead Athletes ◽  
Novel Technique ◽  
Internal Brace

Background: There has been a renewed interest in ulnar collateral ligament (UCL) repair in overhead athletes because of a greater understanding of UCL injuries, an improvement in fixation technology, and the extensive rehabilitation time to return to play. Purpose/Hypothesis: To evaluate the clinical outcomes of a novel technique of UCL repair with internal brace augmentation in overhead throwers. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing a novel technique of UCL repair with internal brace augmentation were prospectively followed for a minimum of 1 year. Potential candidates for repair were selected after the failure of nonoperative treatment when imaging suggested a complete or partial avulsion of the UCL from either the sublime tubercle or medial epicondyle, without evidence of poor tissue quality of the ligament. The final decision on UCL repair or traditional reconstruction was determined intraoperatively. Demographic and operative data were collected at the time of surgery. Return to play, and Kerlan-Jobe Orthopaedic Clinic (KJOC) scores were collected at 1 year and then again at 2 years postoperatively. Results: Of the 111 overhead athletes eligible for the study, 92% (102/111) of those who desired to return to the same or higher level of competition were able to do so at a mean time of 6.7 months. These patients had a mean KJOC score of 88.2 at final follow-up. Conclusion: UCL repair with internal brace augmentation is a viable option for amateur overhead throwers with selected UCL injuries who wish to return to sport in a shorter time frame than allowed by traditional UCL reconstruction.

scholarly journals Medial and Lateral Combined Ligament Arthroscopic Repair for Multidirectional Ankle Instability

2021 ◽  
Vol 6 (1) ◽  
pp. 247301142098615
Author(s):  
Nacime Salomão Barbachan Mansur ◽  
André Vitor Kerber Cavalcante Lemos ◽  
Daniel Soares Baumfeld ◽  
Tiago Soares Baumfeld ◽  
Marcelo Pires do Prado ◽  
...  
Keyword(s):  
Case Series ◽  
Arthroscopic Repair ◽  
Rotational Instability ◽  
Deltoid Ligament ◽  
Ankle Sprains ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Vas Score ◽  
Multidirectional Instability ◽  
Number Of Patients

Background: The high prevalence of ankle sprains in the population produces a significant number of patients with lateral instability. Persistence of this condition may lead to the progressive involvement of medial structures, causing a multidirectional rotational instability. Methods: This is a retrospective study with patients diagnosed with multidirectional instability who underwent ankle arthroscopy with medial (arthroscopic tensioning) and lateral repair (arthroscopic Bröstrom) between January 2018 and January 2020. All patients were evaluated for pain and function according to the visual analog scale (VAS) score and the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score at a mean of 14.8 months (5-27 months) in follow-up. A total of 30 ankles (29 patients) were included in the study. Results: The AOFAS score increase from a 49.7 (CI 5.8) to a 91.9 (CI 2.4) mean ( P = .001) and was followed by significant improvement in the mean VAS score (6.8, CI 0.37-0.95, CI 0.31). The majority of patients had associated procedures (53.3%), and a low complication rate was found (16.6%). Conclusion: Combined medial and lateral arthroscopic repair might be an effective and safe alternative in the treatment of multidirectional instability. Inclusion of the deltoid ligament complex and the low invasiveness of the arthroscopic technique may improve the clinical outcomes of these patients. Level of Evidence: Level IV, retrospective case series.

Deltoid-Spring Ligament Reconstruction in Adult Acquired Flatfoot Deformity With Medial Peritalar Instability

2019 ◽  
Vol 40 (7) ◽  
pp. 753-761 ◽  
Author(s):  
James D. Brodell ◽  
Ashlee MacDonald ◽  
James A. Perkins ◽  
Jonathan T. Deland ◽  
Irvin Oh
Keyword(s):  
Case Series ◽  
Deltoid Ligament ◽  
Measurement Information ◽  
Level Of Evidence ◽  
Spring Ligament ◽  
Radiographic Outcomes ◽  
Metatarsal Angle ◽  
Sf 36 ◽  
Patient Reported ◽  
Adult Acquired Flatfoot Deformity

Background: A spring ligament tear is commonly present in advanced stages of adult acquired flatfoot deformity (AAFD). Previous anatomic studies have demonstrated that the superficial deltoid ligament blends with the superomedial spring ligament, forming the tibiocalcaneonavicular ligament (TCNL). Adding allograft TCNL reconstruction to osseous correction has been suggested to augment medial peritalar stability in advanced AAFD with large spring ligament tears. We aimed to investigate the clinical and radiographic outcomes of TCNL reconstruction for flexible AAFD with medial peritalar instability. Methods: Fourteen feet in 12 patients who underwent osseous and TCNL reconstructions for advanced AAFD (stage IIB with large spring ligament tears or stage IV) were recruited for the study. The mean postoperative follow-up was 24 (range, 12-33) months. Pre- and postoperative clinical outcomes were assessed by the Foot and Ankle Ability Measure (FAAM), SF-36, and Patient-Reported Outcomes Measurement Information System (PROMIS). Correction of forefoot abduction and the sagittal arch were measured from pre- and postoperative weightbearing radiographs. Results: The FAAM Activities of Daily Living improved from 69.3 to 90.1 ( P = .001). The SF-36 Physical Function (PF) and Pain subscales both improved significantly (39.4 to 87.8 and 44.6 to 93.1, respectively, P < .001 for each). The PROMIS PF improved from 38.2 to 46.8 ( P = .002) and the PROMIS Pain Interference (PI) from 62.6 to 50.1 ( P = .003). Radiographic measures showed an improved anterior-posterior (AP) talo–first metatarsal angle of 24.7 to 11.8 degrees ( P < .001) and talonavicular coverage angle of 47.4 to 23.1 degrees ( P < .01). An improved Meary’s angle of 29.7 to 12.5 degrees ( P < .001) and a calcaneal pitch angle of 11.7 to 16.9 degrees ( P = .14) were noted in the lateral view. Conclusion: Considering the anatomic characteristics of the deltoid-spring ligament complex, TCNL reconstruction may play a significant role in maintaining peritalar stability when performed with osseous correction. Deltoid-spring ligament (TCNL) reconstruction is a viable surgical option for those with advanced stage AAFD with medial peritalar instability that leads to improved functional and radiographic outcomes. Level of Evidence: Level IV, retrospective case series.

scholarly journals Postoperative evaluation of posterior tibial tendon transfer

2018 ◽  
Vol 12 (2) ◽  
pp. 145-149
Author(s):  
Larissa Miranda Xavier Vieira ◽  
Rodrigo Barra Caiado Fleury ◽  
Bruno Severino Nunes ◽  
Jefferson Soares Martins ◽  
Edegmar Nunes Costa
Keyword(s):  
Tendon Transfer ◽  
Case Series ◽  
Interference Screw ◽  
Posterior Tibial Tendon ◽  
Drop Foot ◽  
Level Of Evidence ◽  
Posterior Tibial ◽  
Before And After ◽  
Life Improvement ◽  
Therapeutic Study

Objectives: To analyse and report the advantages of posterior tibial tendon transfer amongst patients with drop-foot as well as evaluate the degrees of foot biomechanical restoration and patient quality of life improvement. Methods: Seven patients diagnosed with drop-foot received surgery in which the posterior tibial tendon was transferred via the syndesmotic membrane, and the tendon was fixed to the lateral cuneiform bone using an interference screw. Results: The patients completed the Stanmore questionnaire before and after surgery to report their improvements with regard to all of the questionnaire criteria.Conclusion: The adopted surgical technique is an effective method of disease correction, with associated pain improvement, resumption of wearing shoes, elimination of the regular use of an ankle-foot orthosis (AFO), muscle strength gain, and functional capacity improvement. Level of Evidence IV; Therapeutic Study; Case Series.

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