Evaluación ecográfica del Ligamento Calcáneonavicular (Ligamento de Spring)correlación de hallazgos anatómicos y sonográficos

Abstract

Introduction: The spring ligament (SL) is one of the most important structures responsible for stabilizing the foot, mainly in the plantar arch (PA) maintaining. This ligament is not present or is lax in adults acquired flat foot deformity (AFFD). Due to its location, origin, and insertion in addition to the disposition of its beams, it is a stabilizing element that was meticulously designed to improve the biomechanics of the foot. Ultrasound analysis of this ligament is advantageous due to its speed, ease of use in the clinical field, safety, and efficacy. Objectives: The purpose has been to evaluate intra and inter- rater reliability between ultrasound imaging (US) and caliper measures, to determine Spring ligament (SL) dimensions in cadavers, in order to evaluate the structure’s quality and diagnostic specificity. Material and Methods: SLs were studied from 62 human feet from formaldehyde-embalmed cadavers. Intra and inter-observer reliability of SL length, width and thickness between US and caliper measurements was determined at intra and inter-session by intraclass correlation coefficients (ICC) and Pearson´s correlation coefficients (r). Results: Differentiating between intersession results and results between examiners, we found that SL evaluation by US and caliper between inter-session first and second observer showed excellent inter-rater reliability (ICC(1-1)=0.938-0.994; ICC(1- 1)=0.825-0.998) with a strong correlation (r=0.893-0.989; r=0.725- 0.998; P<0.001) for all dimensions (width, length and thickness), respectively, and there were not inter-rater statistically significant differences (P>0.05) for all measurement even though there were for width measurements by US (P < 0.05). Comparing both US and caliper, SL evaluation between inter-session US and caliper measurements for both observers showed an excellent inter-rater reliability (ICC(1-1)=0.911-0.966) with a strong correlation (r=0.852-0.937; P < 0.001) for all dimensions, and there were not inter-session statistically significant differences (P>0.05) between US and caliper measurements. Conclusion: US and caliper could be recommended for all SL measurements evaluation due to their excellent reliability and strong correlation in cadavers, although width measurements should be taken with caution due to US repeatability differences