Arthroscopic Repair of Superomedial Spring Ligament by Talonavicular Arthroscopy Tun Hing Lui, M.B.B.S.(HK), F.R.C.S.(Edin), F.H.K.A.M., F.H.K.C.O.S. Arthroscopy Techniques Volume 6, Issue 1, Pages e31-e35 (February 2017) DOI: 10.1016/j.eats.2016.08.034 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 1 Preoperative magnetic resonance imaging (sagittal view) showing a tear of the spring ligament (SL) with ganglion (G) formation. (Nav, navicular bone; ST, sustentaculum tali; T, talus.) Arthroscopy Techniques 2017 6, e31-e35DOI: (10.1016/j.eats.2016.08.034) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 2 Arthroscopic repair of superomedial spring ligament in the right foot by talonavicular arthroscopy. The patient is in the supine position. The medial midtarsal portal (MP) is the working portal, and the dorsomedial midtarsal portal (DMP) is the viewing portal. The medial midtarsal portal is located at the medial corner of the talonavicular joint, just above the insertion of the tibialis posterior tendon (TPT). The dorsomedial midtarsal portal is located at the talonavicular joint, just medial to the axis of the talar head. (MM, medial malleolus; Nav, navicular bone.) Arthroscopy Techniques 2017 6, e31-e35DOI: (10.1016/j.eats.2016.08.034) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 3 Arthroscopic repair of superomedial spring ligament in the right foot by talonavicular arthroscopy. The patient is in the supine position. The medial portal is the working portal, and the dorsomedial portal is the viewing portal. The extent of the superomedial spring ligament (SMSL) tear is assessed, especially the plantar extent of the tear (T). (TH, talar head.) Arthroscopy Techniques 2017 6, e31-e35DOI: (10.1016/j.eats.2016.08.034) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 4 Arthroscopic repair of superomedial spring ligament in the right foot by talonavicular arthroscopy. The patient is in the supine position. (A) The medial portal (MP) is the working portal, and the dorsomedial portal (DMP) is the viewing portal. Sutures are passed through the stumps of the torn ligament by means of the CPR Viper suture passer (VSP). (B) The Viper suture passer preloaded with No. 2 FiberWire suture is inserted through the medial portal to the talonavicular joint. The head of the passer is slipped into the deep surface of the distal stump of the torn ligament, and the stump is secured. The suture loop is passed through the stump and retrieved to the medial portal. The limbs of the suture are passed through the suture loop, and the suture is tightened with a good bite of the ligament stump. (SMSL, superomedial spring ligament; T, tear of superomedial spring ligament; TH, talar head.) Arthroscopy Techniques 2017 6, e31-e35DOI: (10.1016/j.eats.2016.08.034) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 5 Arthroscopic repair of superomedial spring ligament in the right foot by talonavicular arthroscopy. The patient is in the supine position. The suture limbs of the proximal suture loop are paired with those of the distal suture loop. The hallux undergoes dorsiflexion, and one pair of the suture limbs (SP) is tightened to close up the tear of the superomedial spring ligament. The other pair of suture limbs is tied by means of a knot pusher (KP). (MP, medial midtarsal portal.) Arthroscopy Techniques 2017 6, e31-e35DOI: (10.1016/j.eats.2016.08.034) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions
Fig 6 Arthroscopic repair of superomedial spring ligament in the right foot by talonavicular arthroscopy. The patient is in the supine position. The dorsomedial portal is the viewing portal. The tear of the superomedial spring ligament (SMSL) is closed up after the repair. Arthroscopy Techniques 2017 6, e31-e35DOI: (10.1016/j.eats.2016.08.034) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions