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Reconstruction of the Deltoid-Spring Ligament: Tibiocalcaneonavicular Ligament Complex

Grunfeld, Robert MD; Oh, Irvin MD; Flemister, Samuel MD; Ketz, John MD

Techniques in Foot & Ankle Surgery: March 2016 - Volume 15 - Issue 1 - p 39–46
doi: 10.1097/BTF.0000000000000108
CME Article

Various surgical techniques of deltoid ligament and spring ligament reconstructions in advanced adult-acquired flatfoot deformity have been described. However, none has reported a simultaneous anatomic reconstruction of both the deltoid and spring ligaments. Advanced adult-acquired flatfoot deformity patients often present with combined deltoid and spring ligaments insufficiency, which should be addressed simultaneously to provide adequate correction and maintain static ligamentous stability. We describe a novel anatomic reconstruction of the tibiocalcaneonavicular ligament with peroneus longus allograft. This is the first surgical technique to reconstruct both the deltoid and spring ligament complex.

Level of Evidence: Diagnostic Level 5, expert opinion. See Instructions for Authors for a complete description of levels of evidence.

*Orthopaedic Surgeon, Foot/Ankle, Lower Extremity Reconstruction, Trauma, Powder River Orthopedics & Spine, Campbell County Health, Gillette, WY

Assistant Professor

Professor, Department of Orthopaedics, Division of Foot and Ankle Surgery, University of Rochester, Rochester, NY

The authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.


Techniques in Foot & Ankle Surgery includes CME-certified content that is designed to meet the educational needs of its readers. This activity is available for credit through February 28, 2017.

Earn CME credit by completing a quiz about this article. You may read the article here, on the TFAS website, or in the TFAS iPad app, and then complete the quiz, answering at least 80 percent of the questions correctly to earn CME credit. The cost of the CME exam is $10. The payment covers processing and certificate fees. If you wish to submit the test by mail, send the completed quiz with a check or money order for the $10.00 processing fee to the Lippincott CME Institute, Inc., Wolters Kluwer Health, Two Commerce Square, 2001 Market Street, 3rd Floor, Philadelphia, PA 19103. Only the first entry will be considered for credit, and must be postmarked by the expiration date. Answer sheets will be graded and certificates will be mailed to each participant within 6 to 8 weeks of participation.

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Accreditation Statement

Lippincott Continuing Medical Education Institute, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement

Lippincott Continuing Medical Education Institute, Inc., designates this journal-based CME activity for a maximum of 1 (one) AMA PRA Category 1 CreditTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Address correspondence and reprint requests to Robert Grunfeld, MD, Foot/Ankle, Lower Extremity Reconstruction, Trauma, Powder River Orthopedics & Spine, Campbell County Health, 508 Stocktrail Ave, Gillette, WY 82716. E-mail:

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