Hospital for Special Surgery, New York, NY, USA.
Foot Ankle Int. 2023 Apr;44(4):363-374. doi: 10.1177/10711007231157657. Epub 2023 Mar 16.
Spring ligament reconstruction (SLR) has been suggested as an adjunct to other reconstructive procedures to potentially avoid talonavicular joint fusion in progressive collapsing foot deformity (PCFD) with severe abduction deformity. Most clinical reports present short-term follow-up data and a small number of patients. The purpose of this study was to examine the medium- to long-term outcomes of an SLR using allograft tendon augmentation as part of PCFD surgical reconstruction. This study to our knowledge represents the largest number of patients and the longest follow-up to date.
This study retrospectively reviewed 26 patients (27 feet, mean age of 61.4 years) who underwent SLR with allograft tendon as part of PCFD reconstruction. The mean follow-up of the cohort was 8 years (range, 5-13.4). Radiographic evaluation consisted of 5 parameters including talonavicular coverage angle (TNC), with the maintenance of correction being evaluated by comparing parameters from the early postoperative period (mean: 11.6 months, range, 8-17) to final follow-up. Foot and Ankle Outcome Score (FAOS) and patient satisfaction questionnaires were collected at final follow-up. Conversion to talonavicular or subtalar fusion was considered as a failure.
Final radiographs demonstrated successful abduction correction, with the mean TNC improving from 43.7 degrees preoperatively to 14.1 degrees postoperatively (P < .0001). All other radiographic parameters improved significantly and exhibited maintenance of the correction. All FAOS subscales showed significant improvement. Responses to the satisfaction questionnaire were received from all except 1 patient, of whom 88.5% (23/26) were satisfied with the results, 96.2% (25/26) would undergo the surgery again, and 88.5% (23/26) would recommend the surgery. Eight feet (29.6%) required painful hardware removal and 1 (3.7%) developed nonunion of the lateral column lengthening osteotomy. No patient required conversion to talonavicular or subtalar fusion.
This study demonstrates favorable medium- to long-term outcomes following PCFD reconstruction including an SLR with allograft tendon augmentation.
Level IV, case series.
在进行其他重建手术时，建议进行距舟背侧韧带重建（SLR），以潜在避免严重外展畸形的进行性塌陷足畸形（PCFD）患者行距舟关节融合术。大多数临床报告均为短期随访数据，且患者数量较少。本研究旨在检查使用同种异体肌腱增强的 SLR 作为 PCFD 手术重建的一部分的中期至长期结果。据我们所知，该研究代表了迄今为止患者数量最多和随访时间最长的研究。
本研究回顾性分析了 26 例患者（27 足，平均年龄 61.4 岁），这些患者接受了 SLR 联合同种异体肌腱，作为 PCFD 重建的一部分。该队列的平均随访时间为 8 年（范围 5-13.4 年）。影像学评估包括 5 个参数，包括距舟覆盖角（TNC），通过比较术后早期（平均：11.6 个月，范围 8-17 个月）和最终随访时的参数，评估矫正的维持情况。在最终随访时收集足部和踝关节结局评分（FAOS）和患者满意度问卷。将距舟或距下融合视为失败。
最终的 X 光片显示成功纠正了外展畸形，TNC 平均值从术前的 43.7 度改善到术后的 14.1 度（P<.0001）。所有其他影像学参数均显著改善，并保持了矫正效果。所有 FAOS 亚量表均显示出显著改善。除 1 例患者外，其余患者均收到了对满意度问卷的回复，其中 88.5%（23/26）对结果满意，96.2%（25/26）会再次接受手术，88.5%（23/26）会推荐手术。8 足（29.6%）需要取出疼痛的内固定物，1 足（3.7%）发生外侧柱延长截骨术不愈合。无患者需要行距舟或距下融合术。
本研究显示，在进行包括同种异体肌腱增强的 SLR 在内的 PCFD 重建手术后，中期至长期结果良好。
IV 级，病例系列研究。
