Reconstruction of the Spring Ligament Using a Peroneus Longus Autograft Tendon Transfer

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Abstract
Background: The spring (calcaneonavicular) ligament provides one of the main static supports of the medial arch of the foot. The purpose of this study was to retrospectively assess the results of patients having undergone reconstruction of the spring ligament using a peroneus longus tendon autograft left at its distal attachment and passed through the navicular followed by either a calcaneal or tibial drill hole, a technique not previously reported. Materials and Methods: Thirteen consecutive patients (14 feet) (mean age, 63.5 ± 12.3 years) undergoing flatfoot surgery with spring ligament reconstruction for cases in which lateral column lengthening failed to correct talonavicular deformity were reviewed. The AOFAS, FAOS, and SF-36 were assessed along with standard weight-bearing radiographs at a followup visit at a mean of 8.9 ± 1.8 years after surgery. Hindfoot alignment and eversion strength were measured. Results: The AOFAS ankle-hindfoot score increased from 43.1 to 90.3 ( p 0.001). The postoperative FAOS pain subscale and overall SF-36 were 83.7 (range, 67.9 to 100), and 77.3 (range 37.8 to 95.6) respectively. The AP first tarsometatarsal angle ( p = 0.015), talonavicular coverage angle ( p = 0.003), lateral calcaneal pitch ( p = 0.002), and lateral talonavicular angle ( p = 0.017) improved significantly and were within normal ranges postoperatively. The mean hindfoot alignment measured 2.7 degrees of valgus. All but one patient had normal (5/5) eversion strength. Conclusion: Reconstruction of the spring ligament resulted in few complications and might be considered as an alternative to arthrodesis in patients with ruptures of the spring ligament and deformity that does not correct fully with bony procedures alone. Level of Evidence: IV, Retrospective Case Series