Hello, I would like to thank the AOFAS and Academy for giving our group the opportunity to present this research. I'm Jessica Coring and the title of our presentation is, excuse me, the title of our research is Radiographic Outcomes After Flexible Flatfoot Reconstruction with and without Spring Ligament Reconstruction. This research was done at the University of Rochester and my co-authors are listed below. There are no disclosures related to this research. The Spring Ligament Complex, or calcaneonavicular ligament, is an important static restraint of the medial longitudinal arch. Failure of the Spring Ligament Complex has been implicated in the development of acquired flatfoot deformity. Loss of stabilization of the medial longitudinal arch leads to pes planus, hindfoot valgus, as well as forefoot abduction. In stage 2 adult acquired flatfoot deformity, there is a flexible deformity with varying degrees of peritalar subluxation. The optimal surgical treatment for stage 2 adult acquired flatfoot deformity remains a controversial topic among foot and ankle surgeons. Common procedures described include medializing calcaneal osteotomy, lateral column lengthening, medial column arthrodesis, as well as hindfoot arthrodesis. There are also multiple soft tissue procedures described to correct the quinus of the hindfoot as well as support the midfoot including augmentation of the failed posterior tibialis tendon with tendon transfer, either the FDL or FHL, as well as spring ligament repair or reconstruction, which this study was focused on. We sought to answer if reconstructing or repairing the spring ligament during flexible flatfoot reconstruction has an impact on postoperative radiographic outcomes. We also aimed to determine if there is a difference among different types of spring ligament reconstruction or repair techniques in the postoperative radiographic outcomes. This was a retrospective review over 12 years where we evaluated the immediate preoperative and latest follow-up radiographs available for review of weight-bearing views of the foot and ankle. We used eight standard radiographic measurements for flatfoot deformity as described in previous literature on weight-bearing radiographs both pre- and postoperative life, including Taylor tilt, Taylor first metatarsal angle, Taylor second metatarsal angle, Taylor navicular and coverage angle, Miri's angle, calcaneal pitch, as well as medial and lateral column height. We analyzed three different groups, where in the first group the spring ligament was not addressed, in the second group direct repair of the spring ligament was performed using suture, and finally our third group where spring ligament reconstruction was performed using a suture tape device. All patients also underwent concomitant medializing calcaneal osteotomy and or lateral column lengthening, as well as FDL tendon transfer. This table shows a breakdown of the additional procedures performed. Over 95% of patients also underwent a concomitant gastrocnemius recession and or tendoachilles lengthening. Other procedures performed listed by group include a cotton osteotomy or lapidus, additional mid-foot fusions, as well as deltoid repair or reconstruction. In all we had 82 patients included along with 84 feet available for evaluation. Here are the breakdown of the demographic variables for the three different groups. We found no differences in preoperative radiographic measurements between the three groups. Overall average for the three groups for follow-up was approximately 90 weeks, with broken down for the spring ligament repair and reconstruction groups of approximately a year follow-up, and then in the group where there was no spring ligament repair, it was almost a two year follow-up. Both the spring ligament repair and reconstruction groups showed post-operative radiographic improvements and their anatomic alignment and radiographic measurements that were sustained at a year post-operatively. This table shows that the post-operative radiographic measurements for the three different groups with the spring ligament repair reconstruction using the suture tape device in green, the direct repair of the spring ligament with suture in orange, and then the group that did not undergo spring ligament repair in blue. We found that post-operatively, both the spring ligament repair and reconstruction groups showed statistically significant improvements in all radiographic measurements when compared to the group of patients that did not undergo spring ligament repair. We did not find any differences between the two spring ligament repair or reconstruction groups. In conclusion, spring ligament reconstruction with either a suture tape device or suture repair alone demonstrated significant improvements in post-operative radiographic outcomes after undergoing flexible flat foot reconstruction at an average of two years after surgery as compared to patients that did not undergo spring ligament repair. The results of our study thus support spring ligament repair or reconstruction for patients when performing flexible flat foot reconstruction for stage 2 adult acquired flat foot deformity. In conclusion, future research directions from this study include correlating patient reported outcomes with radiographic outcomes, looking at longer-term follow-up on radiographic outcomes, as well as performing randomized perspective studies. Thank you for your attention.

radiographic outcomes

flexible flatfoot reconstruction

spring ligament reconstruction

calcaneonavicular ligament

adult acquired flatfoot deformity