title: Anatomic Reconstruction Technique for a Plantar Calcaneonavicular (Spring) Ligament Tear.
abstract: Acquired flatfoot deformity in adults is usually due to partial or complete tearing of the posterior tibial tendon, with secondary failure of other structures such as the plantar calcaneonavicular (spring) ligament (SL), which maintain the medial longitudinal arch. In flexible cases, the tibialis posterior can be replaced with the flexor digitorum longus. It is common practice to suture the SL directly in the case of a tear; however, if the tear is complete, suturing directly to the ligament alone will not be possible. Reconstruction of the ligament is needed; however, no validated methods are available to reconstruct this ligament. The operative technique of SL reconstruction described in this report as a part of acquired flatfoot deformity reconstruction consists of augmenting remnants of the spring from the navicularis to the sustentaculum tali and suspending it to the medial malleolus using 2-mm-wide, long-chain polyethylene suture tape. This technique results in the firm anatomic reconstruction of the SL, in addition to "classic" medial arch reconstruction. We recommend SL reconstruction for medial arch reconstruction when the SL is torn.
authors.affiliation: Orthopedics Department, Meir Medical Center, Kfar-Saba, Israel, associated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: ezepalm@gmail.com.
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Palmanovich
authors.affiliation: Orthopedics Department, Meir Medical Center, Kfar-Saba, Israel, associated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Shay
authors.initials: S
authors.lastname: Shabat
authors.affiliation: Orthopedics Department, Meir Medical Center, Kfar-Saba, Israel, associated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yaron S
authors.initials: YS
authors.lastname: Brin
authors.affiliation: Orthopedics Department, Meir Medical Center, Kfar-Saba, Israel, associated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Viktor
authors.initials: V
authors.lastname: Feldman
authors.affiliation: Orthopedics Department, Meir Medical Center, Kfar-Saba, Israel, associated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Benny
authors.initials: B
authors.lastname: Kish
authors.affiliation: Orthopedics Department, Meir Medical Center, Kfar-Saba, Israel, associated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Meir
authors.initials: M
authors.lastname: Nyska
mesh_terms: D005413:Flatfoot / Q000601:surgery*; D006801:Humans; D000069262:Plantar Plate / Q000293:injuries / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*
keywords: FiberTape™; calcaneus; ligament repair; medial arch reconstruction; navicular; talus