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Novel reconstruction technique for an isolated plantar calcaneonavicular (SPRING) ligament tear: A 5 case series
Ezequiel Palmanovich1, Shay Shabat1, Yaron S Brin1
1Orthopedics Department, Meir Medical Center-Kfar Saba Israel, Associated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Background:
It is usually accepted that acquired flatfoot deformity after injury is usually due to partial or complete tear of the posterior tibial tendon (PTT), with secondary failure of the other structures which maintain the medial longitudinal arch, such as the plantar calcaneo-navicular (SPRING) ligament. It is unusual to find an isolated Spring Ligament (SL) tear, with an intact TP tendon.
Methods:
The medial arch reconstruction technique of an isolated SL tear in 5 patients is presented discussed in this paper. In these 5 cases the clinical presentation mimicked PTT dysfunction. The operative regimen consisted of three steps: direct repair of the ligament, primary reconstruction of the SL by using FiberWire® (Arthrex, Inc) and a medial calcaneal osteotomy.
Results:
American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score improved from 55.8 (range, 34-74) before surgery to 97.6 (range, 91-100) at more than one year follow-up. No recurrence of the flatfoot deformity was observed at 10 years follow-up.
Conclusion:
SL tear should be suspected in cases of clinical presentation of medial arc collapse even when PTT is intact. In such cases of isolated SL tear reconstruction of the torn ligament using the method described is recommended.
