Baxter Josh R, LaMothe Jeremy M, Walls Raymond J, Prado Marcelo Pires, Gilbert Susannah L, Deland Jonathan T
Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.
Foot Ankle Int. 2015 Apr;36(4):424-9. doi: 10.1177/1071100714558512. Epub 2014 Nov 3.
Reconstructing the ligamentous constraints of the medial arch associated with adult acquired flatfoot deformity remains a challenge. The purpose of this study was to test the efficacy of several reconstruction techniques of the medial arch. We hypothesized that an anatomic reconstruction of the spring ligament complex would correct the deformity better than other techniques tested.
Three reconstructions of the medial support structures were performed on each specimen to recreate the different lines of action and insertions of the medial ligamentous complex in 12 specimens with a simulated flatfoot deformity. Talonavicular and tibiocalcaneal (hindfoot) orientations were measured in the axial, sagittal, and coronal planes in the intact, flatfoot, and reconstructed conditions.
While each reconstruction technique corrected the deformity (P < .05), proximal fixation of the graft corrected the greatest amount of talonavicular deformity while also correcting hindfoot valgus (P < .05).
The fixation points and lines of action of a medial arch reconstruction have important implications on deformity correction in a flatfoot model. Despite its fidelity to the native structure, the anatomic spring ligament reconstruction provided the least amount of correction. These findings suggest that other ligamentous structures of the medial arch are critical in supporting the midfoot.
Reconstruction of the ligamentous supports of the medial arch might be able to correct substantial amounts of deformity without osseous procedures like calcaneal osteotomies or midfoot fusions.
重建与成人获得性平足畸形相关的内侧足弓韧带约束仍然是一项挑战。本研究的目的是测试几种内侧足弓重建技术的疗效。我们假设弹簧韧带复合体的解剖重建比其他测试技术能更好地矫正畸形。
对12个模拟平足畸形的标本中的每个标本进行内侧支撑结构的三种重建，以重现内侧韧带复合体不同的作用线和附着点。在完整、平足和重建状态下，在轴向、矢状和冠状平面测量距舟关节和胫跟关节（后足）的方向。
虽然每种重建技术都能矫正畸形（P <.05），但移植物的近端固定矫正距舟关节畸形的程度最大，同时也矫正了后足外翻（P <.05）。
内侧足弓重建的固定点和作用线对平足模型中的畸形矫正具有重要意义。尽管解剖学弹簧韧带重建与天然结构相似，但提供的矫正量最少。这些发现表明，内侧足弓的其他韧带结构对中足的支撑至关重要。
内侧足弓韧带支撑结构的重建可能无需跟骨截骨术或中足融合术等骨性手术就能矫正大量畸形。
