The Therapeutic Evaluation For The Treatment Of Painful Accessory Navicular By Posterior Tibial Tendon Reconstrction Combined With Anchor

Objective:Based on the similar reconstruction theory that the posterior tibial tendon is the most important power stabilized device to maintain the medial longitudinal arch and the most powerful adductor system of plantar flexor varus foot,Kidner procedure and modified Kidner procedure with anchor invole accessory navicular resection and transplanting the posterior tibial tendon to the plantar medial of the navicular nodule,in order to recover the normal tendon-bone combination anatomical location of posterior tibial tendon and the continuity and integrity of the posterior tibial tendon structure,which can keep a certain tension in the posterior tibial tendon to maintain the medial longitudinal arch height and prevent medial longitudinal arch collapse.The retrospective analysis controlled study was performed to investigate the functional outcomes of TwinFix anchor posterior tibial tendon reconstruction procedure and Kidner procedure,providing choices for the surgical treatment of painful accessory navicular.Methods:During January 2013 to September 2016,58 patients with painful accessory navicular underwent surgery in department of orthopedics of our hospital.After completed clinical data,30 cases received TwinFix anchor posterior tibial tendon reconstruction procedure as one group,and the rest cases received Kidner procedure as another group.There was no significant difference in gender,age,affected foot,period before surgery,and classification between 2 group(P>0.05).Operation time was recorded.In Preoperation and final fellow-up The American Orthopaedics Foot and Ankle Society(AOFAS)Midfoot Scale and a visual analog scale(VAS)were used to evaluate the functional painful outcomes;five angles were measured in the weight-bearing anteroposterior and lateral radiographs namely calcaneal inclination angle(CI),lateral talocalcaneal angle(L TC),lateral talar-1 first metatarsal angle(L TMT),anteroposterior talar-first metatarsal angle(AP TMT)and talonavicular coverage angle(TCA).Recovery normal activity time and satisfaction rates and complications were recorded.Results:In group 1,1 male(1 foot,left foot,clinical classification?b)lost to follow-up was exclued,57 feet of 57 patients underwent strictly systematic clinical follow-up in this study.1.Follow-up periodThe patients were followed up 13-33 months(mean,23.93±4.21months)in group 1 and 18-35 months(mean,24.89±4.26 months)in group 2.2.Operation timeOperation time in group 1 was 45 ~ 65 min,with an average of(54.17±5.54)min and 54~70 min in group 2,with an average of(61.32±4.47)min.The operation time in first group was shorter than in second group,differences were statistically significant(P<0.05).3.Functional and pain improvementIn group 1,the mean preoperative AOFAS midfoot scale and VAS scores were(47.28±8.07)and(5.00±1.00),final follow-up were improved to(88.72±1.85)and(1.00±1.50),respectively.In group 2,mean preoperative AOFAS midfoot and VAS score were(46.50±6.75)and(6.00±1.00),final follow-up were improved to(88.00±2.00)and(1.00±0.75),respectively.Preoperative and final follow-up intraobserver with statistical significance(P< 0.05).However,intraobserver no significant differences(P > 0.05).4.flexible flatfoot deformity correctRadiological results,postoperative follow-up of two groups of patients with calcaneal inclination angle(CI),lateral talocalcaneal angle(L TC),lateral talar-1 first metatarsal angle(L TMT),anteroposterior talar-1 first metatarsal angle(AP TMT)and talonavicular coverage angle(TCA)were significantly improved respectively,compared with preoperatively,with statistical significance(P<0.05).However,preoperative and postoperative follow-up intraobserver no significant differences(P > 0.05).5.Recovery normal activity time and Satisfaction ratesRecovery normal activity time of group 1(13.00±2.00)Weeks was significantly shorter than of group 2(15.00±1.75)Weeks,differences are statistically significant(P<0.05).According to the Patient's Satisfaction Rating System categorical ratings,there were 17 “excellent” scores,10 “good,” and 2 “fair” results in first group,the total excellent rate was 93.10% and 10 “excellent”,7 “good”,and 9 “fair” results in second group,the total excellent rate was 60.71%,with statistical significance was found in the good and excellent rate(P<0.05).6.There were no nerve,vascular injuries,no superficial or deep wound infections complications in both groups.Conclusion:1,Anchor posterior tibial tendon reconstruction procedure and Kidner procedure can also be used in the clinical therapy of painful accessory navicular.The effects of operations are similar.Both were highly secure.Both of the effects are similar,and both of them showing high security.2.Anchor posterior tibial tendon reconstruction procedure,such as operation time shorter,minimally surgical trauma,simple operation,early recovery normal activity,highly patient's satisfaction rates,this procedure shoud be priorily choosen for the patients with painful accessory navicular requireing short the postoperative recovery time.