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The concurrence of tears of the scapholunate (SL) and lunotriquetral (LT) ligaments is not unusual and can also occur without an apparent perilunate dislocation. Badia and Khanchandani called this combined lesion a "floating lunate" because the ligamentous attachments on both sides of the lunate are absent and the lunate floats in a neutral position. There have been few published papers referring to the treatment of this kind of instability. In recent years, we have developed an arthroscopic ligamentoplasty for SL instability. However, this procedure is not indicated whether the LT ligament is also damaged. With this current modification, both the strongest portions of the SL and LT ligaments can be reconstructed without opening the joint, thereby avoiding an open approach. We have described this as an "S"-shaped ligamentoplasty, as the graft resembles an "S" as it travels inside the scaphoid, lunate, and triquetrum. The same postoperative early mobilization protocol can be applied to this kind of reconstruction.

Background: Surgical treatment of adult acquired flatfoot deformity can involve arthrodesis of the midfoot to stabilize the medial column. Few experimental studies have assessed the biomechanical effects of these fusions, because of the difficulty of measuring these parameters in cadavers. Our objective was to quantify the biomechanical stress caused by various types of midfoot arthrodesis on the Spring ligament. To date this is not known., Methods: An innovative finite element model was used to evaluate flatfoot scenarios treated with various combinations of midfoot arthrodesis. All the bones, cartilages and tissues related to adult acquired flatfoot deformity were included, respecting their biomechanical characteristics. The stress changes on the Spring ligament were quantified. Both foot arch lengthening and falling were measured for each of the midfoot arthrodeses evaluated., Findings: Arthrodesis performed for stabilization of the talonavicular joint leads to a higher decrease in stress on the Spring ligament. Talonavicular fusion generated a Spring ligament stress decrease of about 61% with respect to the reference case (without any fusion). However, fusing the naviculocuneiform joints leads to an increase in the stress on the Spring ligament., Interpretation: This important finding has been unknown to date. We advocate caution regarding fusion of the naviculocuneiform joint as it leads to increased stresses across the Spring ligament and therefore accelerates the development of planovalgus., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Treatments of adult acquired flatfoot deformity in early stages (I-IIa-IIb) are focused on strengthening tendons, in isolation or combined with osteotomies, but in stage III, rigidity of foot deformity requires more restrictive procedures such as hindfoot joint arthrodesis. Few experimental studies have assessed the biomechanical effects of these treatments, because of the difficulty of measuring these parameters in cadavers. Our objective was to quantify the biomechanical stress caused by both isolated hindfoot arthrodesis and triple arthrodesis on the main tissues that support the plantar arch., Methods: An innovative finite element model was used to evaluate some flatfoot scenarios treated with isolated hindfoot arthrodesis and triple arthrodesis., Results and Conclusions: When arthrodeses are done in situ, talonavicular seems a good option, possible superior to subtalar and at least equivalent to triple. Calcaneocuboid arthrodesis reduces significantly both fascia plantar and spring ligament stresses but concentrates higher stresses around the fused joint., (Copyright © 2019 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Background: Adult acquired flatfoot deformity (AAFD) is traditionally related to a tibialis posterior tendon deficiency. In the intermediate stages, treatments are commonly focused on reinforcing this tissue, but sometimes the deformation appears again over time, necessitating the use of more aggressive options. Tissue stress cannot be consistently evaluated through traditional experimental trials. Computational foot modeling extends knowledge of the disease and could help guide the clinical decisions. This study analyzes the biomechanical stress of the main tissues related to AAFD and their capacity to support the plantar arch., Methods: A FE foot model was reconstructed. All the bones, cartilages and tissues related to AAFD were included, respecting their biomechanical characteristics. The biomechanical tissue stress was quantified. The capacity of each soft tissue to support the plantar arch was measured, following clinical criteria., Findings: Biomechanical stress of the tibialis posterior tendon is considerably superior to both the plantar fascia and spring ligament stress. However, it cannot maintain the plantar arch by itself. Both the tibialis posterior tendon and spring ligament act in reducing the hindfoot pronation, while the plantar fascia is the main tissue that prevents arch elongation. The Achilles tendon action increases the plantar tissue stress., Interpretation: The tibialis posterior tendon stress increases when the spring ligament or the fascia plantar fails. These findings are consistent with the theory that regards the tibialis posterior tendon as a secondary actor because it cannot support the plantar arch and claudicates when the hindfoot has rotated around the talonavicular joint., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Arthroscopic scapholunate volar and dorsal ligament reconstruction achieves an anatomic reconstruction, avoids an open approach and capsular detachment, and provides a strong construct for early mobilization. Clinical results are discussed. Detailed "surgical tips" and technical modifications are provided., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Classical arthroscopic techniques for scapholunate instability consist of debridement, thermal shrinkage, and percutaneous pinning. Good results are obtained in acute lesions or in chronic partial tears, but they are less predictable when the lesion is complete, because of the poor healing capacity of the scapholunate ligament and because it is not possible to perform an anatomic ligamentous reconstruction with these techniques. Open techniques are thus required for reconstruction, but they damage the soft tissues. We recently published a description and cadaver study of an arthroscopic ligamentoplasty, trying to combine the advantages of arthroscopic techniques (minimally invasive surgery) and open techniques (reconstruction of the ligament). With this approach, it is possible to reconstruct the dorsal scapholunate ligament and the secondary stabilizers while causing minimal damage to the soft tissues and avoiding injury to the posterior interosseous nerve and detachment of the dorsal intercarpal ligament. The current report describes an additional step to this technique with which it is possible to reconstruct the volar portion of the scapholunate ligament. We also describe an early mobilization postoperative protocol that we believe is equally important., (Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)