Endoscopic Spring Ligament Repair. Anatomic Evaluation of Portal Safety
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Published:
Feb 17, 2023
Keywords:
Spring ligament, posterior tibial tendon dysfunction, endoscopic repair of the spring ligament, tendoscopy, progressive collapsing foot deformity, adult flatfoot
Main Article Content
Abstract
Introduction: Calcaneonavicular ligament injury has been described as a cause of adult flat foot deformity. The objective of this study is to describe modified portals for the diagnosis and treatment of injuries to the superomedial bundle of the calcaneonavicular ligament and to evaluate the safety of the portals used.
Materials and Methods: We performed a cadaveric specimen study on 6 feet, where we reproduced a lesion of the superomedial bundle of the calcaneonavicular ligament with a radiofrequency ablation device and repaired it endoscopically. Two modified portals were created for the approach and an anatomical dissection was performed to assess the safety of the portals in relation to the anatomical structures. The first portal was placed immediately proximal to a line drawn from the tip of the medial malleolus toward the center of the heel; the second portal was placed 0.5 cm proximal to the posterior tibial tendon insertion into the navicular bone, guided by transillumination. If needed, an accessory portal was placed halfway between the two previously described portals immediately dorsal to the posterior tibial tendon.
Results: In all cases, ligament repair was achieved with the endoscopic procedure. In the anatomical dissection of the portals, we observed an average distance of 11.83 mm from the proximal portal and 9.66 mm from the distal portal to neurovascular structures.
Conclusion: Modified portals are safe and allow direct visualization of the superomedial bundle of the calcaneonavicular ligament to perform endoscopic repair.
Materials and Methods: We performed a cadaveric specimen study on 6 feet, where we reproduced a lesion of the superomedial bundle of the calcaneonavicular ligament with a radiofrequency ablation device and repaired it endoscopically. Two modified portals were created for the approach and an anatomical dissection was performed to assess the safety of the portals in relation to the anatomical structures. The first portal was placed immediately proximal to a line drawn from the tip of the medial malleolus toward the center of the heel; the second portal was placed 0.5 cm proximal to the posterior tibial tendon insertion into the navicular bone, guided by transillumination. If needed, an accessory portal was placed halfway between the two previously described portals immediately dorsal to the posterior tibial tendon.
Results: In all cases, ligament repair was achieved with the endoscopic procedure. In the anatomical dissection of the portals, we observed an average distance of 11.83 mm from the proximal portal and 9.66 mm from the distal portal to neurovascular structures.
Conclusion: Modified portals are safe and allow direct visualization of the superomedial bundle of the calcaneonavicular ligament to perform endoscopic repair.
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How to Cite
Masaragian, H., Rega, L. A., Perin, F., Ameriso, N., Coria, H. E., Fabrego, C. M., & Veizaga Velasco, J. L. (2023). Endoscopic Spring Ligament Repair. Anatomic Evaluation of Portal Safety. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(1), 113-122. https://doi.org/10.15417/issn.1852-7434.2023.88.1.1645
Section
Basic Research
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References
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6. Jennings MM, Christensen JC. The effects of sectioning the spring ligament on rearfoot stability and posterior tibial tendon efficiency. J Foot Ankle Surg 2008;47(3):219-24. https://doi.org/10.1053/j.jfas.2008.02.002
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2008;14(2):89-95. https://doi.org/10.1016/j.fas.2007.11.005
10. Masaragian HJ, Massetti S, Perin F, Coria H, Cicarella S, Mizdraji L, et al. Flatfoot deformity due to isolated spring ligament injury. J Foot Ankle Surg 2020;59(3):469-78. https://doi.org/10.1053/j.jfas.2019.09.011
11. Masaragian HJ, Ricchetti HO, Testa C. Acute isolated rupture of the spring ligament: A case report and review of the literature. Foot Ankle Int 2013;34(1):150-4. https://doi.org/10.1177/1071100712460222
12. Lui TH. Endoscopic assisted posterior tibial tendon reconstruction for stage 2 posterior tibial tendon insufficiency. Knee Surg Sport Traumatol Arthrosc 2007;15(10):1228-34. https://doi.org/10.1007/s00167-006-0282-8
13. Lui TH. Posterior tibial tendoscopy: Endoscopic synovectomy and assessment of the spring (calcaneonavicular) ligament. Arthrosc Tech 2015;4(6):e819-23. https://doi.org/10.1016/j.eats.2015.08.006
14. Wertheimer SJ, Frascone ST, Loder BG, Calderone DR, Calderone DR, Frascone ST. The role of endoscopy in
treatment of stenosing posterior tibial tenosynovitis. J Foot Ankle Surg 1995;34(1):15-22. https://doi.org/10.1016/S1067-2516(09)80097-5
15. van Dijk CN, Kort N, Scholten PE. Tendoscopy of the posterior tibial tendon. Arthroscopy 1997;13(6):692-8.
https://doi.org/10.1016/s0749-8063(97)90002-5
16. Lui TH. Arthroscopic repair of superomedial spring ligament by talonavicular arthroscopy. Arthrosc Tech
2017;6(1):e31-5. https://doi.org/10.1016/j.eats.2016.08.034
17. Lui TH. Endoscopic repair of the superficial deltoid ligament and spring ligament. Arthrosc Tech 2016;5(3):e621-5. https://doi.org/10.1016/j.eats.2016.02.004
2004;9(1):1-23. https://doi.org/10.1016/S1083-7515(03)00155-4
2. Taniguchi A, Tanaka Y, Takakura Y, Kadono K, Maeda M, Yamamoto H. Anatomy of the spring ligament. J Bone
Joint Surg Am 2003;85(11):2174-8. https://doi.org/10.2106/00004623-200311000-00018
3. Acevedo J, Vora A. Anatomical reconstruction of the spring ligament complex: “Internal brace” augmentation. Foot Ankle Spec 2013;6(6):441-5. https://doi.org/10.1177/1938640013499404
4. Deland JT, Ellis SJ, Day J, Netto CDC, Hintermann B, Myerson MS, et al. Indications for deltoid and spring
ligament reconstruction in progressive collapsing foot deformity. Foot Ankle Int 2020;41(10):1302-6.
https://doi.org/10.1177/1071100720950742
5. Orr JD, Nunley JA. Isolated spring ligament failure as a cause of adult-acquired flatfoot deformity. Foot Ankle Int 2013;34(6):818-23. https://doi.org/10.1177/1071100713483099
6. Jennings MM, Christensen JC. The effects of sectioning the spring ligament on rearfoot stability and posterior tibial tendon efficiency. J Foot Ankle Surg 2008;47(3):219-24. https://doi.org/10.1053/j.jfas.2008.02.002
7. Kelikian AS, Sarrafian SK. Sarrafian’s anatomy of the foot and ankle: descriptive, topographic, functional.
Philadelphia: Lippincott Williams & Wilkins; 2011.
8. Testut L, Latarjet A. Tratado de anatomía humana. Barcelona: Salvat; 1964, vol. 9.
9. Tryfonidis M, Jackson W, Mansour R, Cooke PH, Teh J, Ostlere S, et al. Acquired adult flat foot due to isolated
plantar calcaneonavicular (spring) ligament insufficiency with a normal tibialis posterior tendon. Foot Ankle Surg
2008;14(2):89-95. https://doi.org/10.1016/j.fas.2007.11.005
10. Masaragian HJ, Massetti S, Perin F, Coria H, Cicarella S, Mizdraji L, et al. Flatfoot deformity due to isolated spring ligament injury. J Foot Ankle Surg 2020;59(3):469-78. https://doi.org/10.1053/j.jfas.2019.09.011
11. Masaragian HJ, Ricchetti HO, Testa C. Acute isolated rupture of the spring ligament: A case report and review of the literature. Foot Ankle Int 2013;34(1):150-4. https://doi.org/10.1177/1071100712460222
12. Lui TH. Endoscopic assisted posterior tibial tendon reconstruction for stage 2 posterior tibial tendon insufficiency. Knee Surg Sport Traumatol Arthrosc 2007;15(10):1228-34. https://doi.org/10.1007/s00167-006-0282-8
13. Lui TH. Posterior tibial tendoscopy: Endoscopic synovectomy and assessment of the spring (calcaneonavicular) ligament. Arthrosc Tech 2015;4(6):e819-23. https://doi.org/10.1016/j.eats.2015.08.006
14. Wertheimer SJ, Frascone ST, Loder BG, Calderone DR, Calderone DR, Frascone ST. The role of endoscopy in
treatment of stenosing posterior tibial tenosynovitis. J Foot Ankle Surg 1995;34(1):15-22. https://doi.org/10.1016/S1067-2516(09)80097-5
15. van Dijk CN, Kort N, Scholten PE. Tendoscopy of the posterior tibial tendon. Arthroscopy 1997;13(6):692-8.
https://doi.org/10.1016/s0749-8063(97)90002-5
16. Lui TH. Arthroscopic repair of superomedial spring ligament by talonavicular arthroscopy. Arthrosc Tech
2017;6(1):e31-5. https://doi.org/10.1016/j.eats.2016.08.034
17. Lui TH. Endoscopic repair of the superficial deltoid ligament and spring ligament. Arthrosc Tech 2016;5(3):e621-5. https://doi.org/10.1016/j.eats.2016.02.004