ABSTRACT
Objective:
To explore the
clinical efficacy of reconstructing the calcaneocuboid and calcaneonavicular
ligaments with the autologous
semitendinosus for chronic bifurcate
ligament injury.
Methods:
A
retrospective study was conducted to analyze the clinical data of 12
patients with chronic bifurcate
ligament injury who had been treated by anatomical reconstruction with the autologous
semitendinosus from March 2018 to January 2021 at Department of
Foot and
Ankle Surgery, The Fourth
Hospital of Wuhan. There were 4
males and 8
females with an age of (41.4±9.6) years. Seven left and 5 right
feet were affected; the
time from
injury to
surgery was (9.3±4.3) months. The surgical
efficacy was evaluated based on anteroposterior and lateral imaging assessments of
foot weight-bearing at 6 months postoperation, comparison of the visual analogue scale (VAS)
pain scores for
foot weight-bearing walking and the American Orthopaedic
Foot and
Ankle Society (AOFAS) midfoot scores between preoperation and the last follow-up, stress test for stability of the transverse
tarsal joint, recovery of
movement, and occurrence of
complications.
Results:
All
patients were followed up for (18.4±4.0) months. Their
sports activities were completely resumed after postoperative (6.8±3.9) months. Primary
wound healing was achieved in all
patients. One
patient suffered from cutaneous nerve lesion and
skin numbness, the symptoms of which disappeared after
conservative treatment. Double harmonic curves were observed on the anteroposterior and lateral imaging
films of
foot weight-bearing in all
patients. The spaces in the calcaneocuboid and the calcaneonavicular
joints were normal, the articular positions were matched, and the calcaneocuboid
joint was stable without
recurrence or worsening of displacement. The VAS decreased significantly from preoperative 6.5 (5.6, 7.0) to 0.0 (0.0, 1.0) at the last follow-up, and the AOFAS mid-
foot score increased significantly from preoperative (55.6±8.8) points to (92.3±2.6) points at the last follow-up ( P<0.05). The stress test for the stability of the transverse
tarsal joint showed
joint stability.
Conclusion:
Reconstruction of the calcaneocuboid and calcaneonavicular
ligaments using the autologous
semitendinosus is an alternative
treatment for
patients with chronic bifurcate
ligament injury, because it can restore the stability of the bifurcate
ligament and obviously improve the
foot and
ankle functions with limited
postoperative complications.