Retrospective case series of 14 feet (12 patients) with advanced AAFD (stage IIB with large spring ligament tears ≥1.5 cm, or stage IV) treated with combined osseous correction and allograft TCNL reconstruction — a technique that reconstructs the spring and superficial deltoid ligaments as a single confluent structure spanning the tibiotalar, talonavicular, and subtalar joints. The study reports clinical and radiographic outcomes at mean 24-month follow-up.
When you encounter advanced AAFD with a spring ligament tear >1.5 cm or stage IV disease with deltoid insufficiency (valgus tibiotalar tilt on standing or stress), consider TCNL allograft reconstruction as an adjunct to osseous correction — bony realignment alone may not restore medial peritalar stability across all three joints.
If using the figure-of-eight navicular-to-sustentaculum construct, assess bone stock carefully and avoid passing both the FDL and allograft under tension through the same navicular tunnel to reduce stress fracture risk.
Retrospective case series of 14 feet (12 patients) with advanced AAFD (stage IIB with large spring ligament tears ≥1.5 cm, or stage IV) treated with combined osseous correction and allograft TCNL reconstruction — a technique that reconstructs the spring and superficial deltoid ligaments as a single confluent structure spanning the tibiotalar, talonavicular, and subtalar joints. The study reports clinical and radiographic outcomes at mean 24-month follow-up.
When you encounter advanced AAFD with a spring ligament tear >1.5 cm or stage IV disease with deltoid insufficiency (valgus tibiotalar tilt on standing or stress), consider TCNL allograft reconstruction as an adjunct to osseous correction — bony realignment alone may not restore medial peritalar stability across all three joints.
If using the figure-of-eight navicular-to-sustentaculum construct, assess bone stock carefully and avoid passing both the FDL and allograft under tension through the same navicular tunnel to reduce stress fracture risk.