Spring ligament repair with and without augmentation demonstrates favorable outcomes in progressive collapsing...

Spring ligament disruption is a primary contributor to the development of progressive collapsing flatfoot deformity (PCFD). The purpose of this systematic review is to evaluate the radiographic findings, clinical outcomes, complications, and failures following spring ligament repair with and without augmentation.

During December 2025, the PubMed, Cochrane, and EMBASE library databases were systematically searched to identify studies examining radiographic findings, clinical outcomes, complications, and failures in patients who underwent spring ligament repair with and without augmentation.

Nine studies including 209 patients (212 feet) with spring ligament injuries were analyzed. Patients who underwent spring ligament repair with and without augmentation were evaluated. Both treatment approaches were associated with clinically meaningful improvements in radiographic alignment, with mean talo-first metatarsal angle (TFMA) correction of 12.9° following isolated repair and 11.0° following repair with augmentation. Clinical outcomes also improved, with mean increases in American Orthopaedic Foot and Ankle Society (AOFAS) scores of 24.1 and 29.8 points for isolated repair and repair with augmentation, respectively. Complication rates were low for both isolated repair (4.5 %) and repair with augmentation (6.7 %), with corresponding failure rates of 1.3 % and 3.3 %, respectively.

Spring ligament repair with and without augmentation is associated with meaningful improvements in radiographic alignment and clinical outcomes in patients with PCFD. Across the included studies, both treatment approaches also demonstrated low complication and failure rates. While suture augmentation may provide additional mechanical support in select patients, the available evidence precludes direct comparative conclusions regarding the superiority of the technique over isolated spring ligament repair. Further high-quality, comparative studies are warranted to definitively establish the optimal surgical method for managing spring ligament injuries.

IV.