Abstract
The present prospective study examined the utility of the intraoperative tap test/technique
for distal tibiofibular syndesmosis in the diagnosis of deltoid ligament rupture and
compared the outcomes of transsyndesmotic fixation to deltoid ligament repair with
suture anchor. This diagnostic technique was performed in 59 ankle fractures with
suspected deltoid ligament injury. The width of the medial clear space of 59 cases
was evaluated to assess the sensitivity and specificity. Those with deltoid ligament
rupture were randomly assigned to 2 groups and treated with deltoid ligament repair
with a suture anchor or with syndesmosis screw fixation. All the patients were assessed
with the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale,
short-form 36-item questionnaire (SF-36), and visual analog scale (VAS). The tap test
was positive in 53 cases. However, surgical exploration demonstrated that 51 cases
(86.4%) had a combined deltoid ligament injury and fracture. The sensitivity and specificity
of the tap test was 100.0% and 75.0%, respectively. Finally, 26 cases (96.3%) in the
syndesmosis screw group and 22 (91.7%) in the deltoid repair group were followed up.
No statistically significant differences were found in the AOFAS ankle-hindfoot scale
score, SF-36 score, or VAS score between the 2 groups. The malreduction rate in the
syndesmosis screw group was 34.6% and that in the deltoid repair group was 9.09%.
The tap test is an intraoperative diagnostic method to use to evaluate for deltoid
ligament injury. Deltoid ligament repair with a suture anchor had good functional
and radiologic outcomes comparable to those with syndesmotic screw fixation but has
a lower malreduction rate. We did not encounter the issue of internal fixation failure
or implant removal.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: April 13, 2018
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
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© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
