title: Reconstruction of the medial talonavicular joint in simulated flatfoot deformity.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA baxterj@hss.edu.
authors.forename: Josh R
authors.initials: JR
authors.lastname: Baxter
authors.affiliation: Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Jeremy M
authors.initials: JM
authors.lastname: LaMothe
authors.affiliation: Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Walls
authors.affiliation: Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA Orthopedic Department, Hospital Israelita Albert Einstein, São Paulo-SP, Brazil.
authors.forename: Marcelo Pires
authors.initials: MP
authors.lastname: Prado
authors.affiliation: Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Susannah L
authors.initials: SL
authors.lastname: Gilbert
authors.affiliation: Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Deland
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D005413:Flatfoot / Q000601:surgery*; D005531:Foot Deformities, Acquired / Q000601:surgery; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008953:Models, Anatomic; D019637:Orthopedic Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012680:Sensitivity and Specificity; D013639:Tarsal Bones / Q000601:surgery*; D013640:Tarsal Joints / Q000601:surgery*; D055815:Young Adult
keywords: biomechanics; deformity; flatfoot; spring ligament; talonavicular