2015 ISAKOS Biennial Congress ePoster #107

Middle and Long-Term Outcomes of Arthroscopic Surgery for Subtalar Instability by the Reconstruction of Talocalcaneal Interosseous Ligament Using an Artificial Ligament

Norio Usami, MD, Tokyo JAPAN
Hiroko Ikezawa, MD, Tokyo JAPAN
Kanako Kudo, MD, Tokyo JAPAN
Eiichi Hiraishi, MD, Tokyo JAPAN

Institution of Shoe,foot and ankle disorders, Usami Orthpaedic Clinic, Tokyo, JAPAN

FDA Status Cleared

Summary: The arthroscopoic reconstruction of talocalcaneal interosseous ligament for subtalar instability is a minimum invasive and has been maintaining excellent results at long term periods




Although some reports have appeared to date on the treatments for subtalar instability, a few reports have appeared compared with the surgery of lateral ligament , and no long-term outcomes have been reported. Since 1991, we have been treating patients with subtalar instability with arthroscopic reconstruction of the talocalcaneal interosseous ligament using an artificial ligament. This study mainly investigated the long-term outcomes of these patients.

The study involved 119 feet, including 54 male feet and 65 female feet, in 116 patients that had undergone this surgery between 1991 and 2011. The age of the subjects ranged from 21 to 52 years, with a mean of 28 years. In this method, an arthroscope was inserted from the sinus tarsi to the posterior subtalar joint to create bone holes in the calcaneal and talar regions to which the talocalcaneal interosseous ligament was attached, and a 12-mm-wide tubular artificial ligament was passed through the bone holes to reconstruct the interosseous ligament. Neither the cervical nor calcaneofibular ligament underwent any surgery. Full weight-bearing with a brace was started 2 weeks after surgery, jogging was started 4 weeks after surgery, ordinary sports were started 6 weeks after surgery, and competition-level and contact sports were allowed 8 weeks after surgery. The follow-up period ranged from 3 to 16 years, with a mean of 6 years 7 months.


Pain improved in all patients, and they could return to sports or original jobs. All patients had no limitation of range of motion . No patients required reoperation. Two patients had limitation of range of motion of the hallux. Radiographs showed that no patients had degenerative changes or recurrence of instability over time. Furthermore, second-look one to two years after surgery also showed that the artificial ligament was covered with regenerated tissue, that its tension was maintained, and that there was no abrasion or inflammatory findings.


Most conventional treatments for subtalar instability involve reconstruction or reinforcement of the cervical or calcaneofibular ligament. Stability is thereby improved, but limitation of range of motion occurs, because the treatments are not focused on the cause of instability. It is certain that subtalar instability is caused by injury of the interosseous talocalcaneal ligament based on subtalar arthroscopic findings. Our approach of arthroscopic reconstruction of the interosseous talocalcaneal ligament using an artificial ligament is based on this finding. There was no recurrence of pain, reduction in the levels of activity of daily life, or reduction in limitation of joint range of motion even in patients who had undergone surgery more than 5 years previously. We think that this method is useful because it gives good long-term results without sacrificing autologous tissue.