title: Periosteal repair of the dorsal calcaneocuboid ligament: a comparative biomechanical study.
abstract: BACKGROUND
  Isolated lateral calcaneocuboid joint instability rarely is described. Missed or delayed diagnosis resulting in inadequate treatment may lead to chronic instability, followed by sports inability and handicap in daily life. Besides arthrodesis, anatomic repair augmenting the elongated dorsal calcaneocuboid ligament with a local periosteal flap has recently been described for treatment.
  
  
  METHODS
  In a controlled laboratory study, eight isolated fresh-frozen human cadaver calcaneocuboid specimens were strained in a varus direction until failure of the dorsal calcaneocuboid ligaments. Then the dorsal calcaneocuboid ligaments were reconstructed with free periosteal flaps and tensile testing was repeated.
  
  
  RESULTS
  Compared to native dorsal calcaneocuboid ligaments, free single layer periosteal flap reconstructions were found to have inferior load to failure (-52%, p = 0,028), ultimate stress (-44%, p = 0.024), stiffness (-50%, p = 0.063), and strain energy density to failure (-37.5%, p = 0.111).
  
  
  CONCLUSIONS
  In vitro data demonstrate that isolated single-layer periosteal flap replacement offers inferior stability as compared to native dorsal calcaneocuboid ligaments. To obtain sufficient initial stability, the elongated native ligament should, therefore, be reefed and a single-layer periosteal flap augmentation should be added. This combined procedure can be recommended for stabilization of isolated chronic dorsolateral calcaneocuboid joint instability.
authors.affiliation: Institute for Sports Medicine Frankfurt/Main, Otto-Fleck-Schneise 10, 60528 Frankfurt/Main, Germany. lohrer@sport.uni-frankfurt.de
authors.forename: Heinz
authors.initials: H
authors.lastname: Lohrer
authors.forename: Tanja
authors.initials: T
authors.lastname: Nauck
authors.forename: Nadja V
authors.initials: NV
authors.lastname: Dorn-Lange
authors.forename: Sabine
authors.initials: S
authors.lastname: Arentz
authors.forename: Moritz A
authors.initials: MA
authors.lastname: Konerding
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D010521:Periosteum / Q000601:surgery*; D013524:Surgical Flaps; D013640:Tarsal Joints / Q000601:surgery*