A Novel Fibertape Scaffold Technique for Medial Ligament Reconstruction Combined with Minimally Invasive Calcaneal Osteotomy in Stage II Adult Acquired Flatfoot Deformity: A Prospective Study of 20 Patients
Vivek Kumar Gupta, Girish Motwani, Abhijit BandyopadhyayAbstract
Background:
Adult acquired flatfoot deformity (AAFD) is characterized by the collapse of the medial longitudinal arch, often due to posterior tibial tendon dysfunction or spring ligament insufficiency. While traditional surgical approaches, such as tendon transfers and osteotomies, have been employed, they frequently fail to address the underlying ligamentous instability in advanced cases. This study presents a novel technique that involves the use of a quadrangular fibertape scaffold to reconstruct both the spring and deltoid ligaments, combined with medial displacement calcaneal osteotomy (MDCO) without lateral column lengthening (LCL).
Materials and Methods:
Between October 2020 and June 2022, 20 patients (mean age = 49.6 years; 9 males and 11 females) with stage II AAFD who had failed conservative management were enrolled. Exclusion criteria included those with previous foot surgeries, active infections, and neurological disorders. A comprehensive clinical and radiological evaluation, including American Orthopedic Foot and Ankle Society’s (AOFAS) scores and multiple radiographic parameters (Meary’s angle, talocalcaneal angle, talonavicular coverage, and tibiocalcaneal angle), was performed preoperatively and at 3 and 12 months postoperatively. The surgical technique involved minimally invasive MDCO and tibiocalcaneonavicular ligament reconstruction using a quadrangular fibertape scaffold.
Results:
Significant improvements in radiographic parameters were observed at 3 and 12 months postoperatively, including the Meary’s angle, talocalcaneal angles, talonavicular coverage, and tibiocalcaneal angles (
Conclusion:
The quadrangular fibertape scaffold technique, combined with MDCO, offers a novel and effective solution for treating stage II AAFD by addressing both soft tissue and bony components. This method provides improved medial ligament stability and foot alignment, with reduced morbidity compared to traditional procedures. The results suggest that this combined approach may redefine the standard of care for advanced flatfoot deformity. Further studies with long-term follow-up are needed to validate these findings.
Level of Evidence:
Level IV, case series.