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Rougereau G, Marty-Diloy T, Vigan M, Donadieu K, Vialle R, Langlais T, Hardy A. Biomechanical evaluation of the spring ligament and the posterior tibial tendon by shear-waves elastography: validation of a reliable and reproducible measurement protocol. J Exp Orthop 2023; 10:121. [PMID: 38006458 PMCID: PMC10676337 DOI: 10.1186/s40634-023-00678-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/19/2023] [Indexed: 11/27/2023] Open
Abstract
PURPOSE The anatomy of the spring ligament complex, as well as its pathology, is not well known in daily clinical practice. The purpose of this study was to evaluate the shear-wave elastography properties of the spring ligament and the posterior tibial tendon in healthy adults, and to assess the reliability and reproducibility of these measurements. METHODS Shear-wave elastography was used to evaluate both ankles in 20 healthy patients (10 females/10 males) resting on a hinge support with their ankles in neutral, valgus 20° and varus 30° positions. The stiffness of the spring ligament and posterior tibial tendon was assessed by measuring the speed of shear wave propagation through each structure. RESULTS Posterior tibial tendon and spring ligament reach a maximum estimated stiffness in valgus 20° position (7.43 m/s vs 5.73 m/s, respectively). Flat feet were associated with greater spring ligament stiffness in the 20° valgus position (p = 0.01), but not for the posterior tibial tendon (p = 0.71). The physiologic weightbearing hindfoot attitude had no impact on the stiffness of the posterior tibial tendon or the spring ligament, regardless of the analysis position. Intra- and inter-observer agreements were all excellent for spring ligament stiffness, regardless of ankle position, and were good or excellent for posterior tibial tendon. CONCLUSIONS This study describes a protocol to assess the stiffness of tibialis posterior and the spring ligament by shear-wave elastography, which is reliable, reproducible, and defines a corridor of normality. Further studies should be conducted to define the role of elastography for diagnosis/ evaluation of pathology, follow-up, or surgical strategies.
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Affiliation(s)
- Grégoire Rougereau
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, 75571, Paris, France.
- Department of Adult Orthopedic Surgery, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75571, Paris, France.
| | - Thibault Marty-Diloy
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, 75571, Paris, France
| | - Marie Vigan
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, 75571, Paris, France
- Unité de Recherche Clinique Hôpitaux Universitaires Paris Ile-de-France Ouest, APHP, 92100, Boulogne-Billancourt, France
| | - Kalinka Donadieu
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, 75571, Paris, France
| | - Raphaël Vialle
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, 75571, Paris, France
- Department for Innovative Therapies, Musculoskeletal Disease Sorbonne University, The MAMUTH Hospital University, Paris, France
| | - Tristan Langlais
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, 75571, Paris, France
- Department of Pediatric Orthopedic Surgery, Toulouse University, Children's Hospital, Purpan, Toulouse, France
| | - Alexandre Hardy
- Department of Orthopedic Surgery, Clinique du Sport, 75005, Paris, France
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Chien BY, Greisberg JK, Arciero E. Spring Ligament Reconstruction for Progressive Collapsing Foot Deformity: Contemporary Review. Foot Ankle Int 2023; 44:796-809. [PMID: 37341112 DOI: 10.1177/10711007231178538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
The spring ligament is one of the main stabilizers of the medial arch of the foot and the primary static supporter of the talonavicular joint. Attenuation or rupture of this ligament is thought to play a central role in the pathophysiology of progressive collapsing foot deformity. Traditional correction of flexible flatfoot consists of posterior tibial tendon augmentation along with various osteotomies or hindfoot fusions. Repair or reconstruction of the spring ligament has not been as widely pursued. In recent years, newer techniques have been explored and may improve outcomes of traditional procedures, or possibly entirely replace some osteotomies. Combined spring-deltoid ligament reconstruction is also gaining traction as a viable technique, particularly as the ankle begins to deform into valgus. This review summarizes the variety of nonanatomic and anatomic reconstruction techniques that have been described, including autologous tendon transfers, allografts, and synthetic augmentation. Although many have only been characterized in biomechanical cadaver studies, this article reviews preliminary clinical studies that have shown promising results. There is a need for more high-quality studies evaluating the clinical, radiographic, and patient-reported outcomes following spring ligament reconstruction.
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Affiliation(s)
- Bonnie Y Chien
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Justin K Greisberg
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Emily Arciero
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY, USA
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Mateen S, Van JC. Ligament Insufficiency with Flatfoot: Spring Ligament and Deltoid Ligament. Clin Podiatr Med Surg 2023; 40:307-314. [PMID: 36841581 DOI: 10.1016/j.cpm.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The objective of this article was to review the deltoid ligament and spring ligament specifically as they pertain to ligament insufficiency and adult-acquired flatfoot deformity. Discussion includes the normal and abnormal biomechanical forces that extend through these ligaments in normal and flatfoot deformity. Current literature related to spring ligament repair as part of the flatfoot deformity reconstruction is also reviewed.
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Affiliation(s)
- Sara Mateen
- Foot and Ankle Deformity and Orthoplastics, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA
| | - Jennifer C Van
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, 148 North 8th Street, Philadelphia, PA 19107, USA.
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