Abstract
Primary repair of the deltoid ligament is a common surgical option for unstable ankle
fracture. However, controversy exists regarding whether such repair is necessary or
provides any benefit to patient outcomes. A retrospective study was performed following
acute deltoid repairs using all-suture bone anchors. Patients at two surgical centers
were included when they were over 18 years old at surgery, had a medial clear space
(MCS) greater than 4mm preoperatively, and had at least six months of follow-up. Subjective
outcomes were measured with PROMIS, FAAM, and numeric rating scale. Preoperative and
follow-up scores were compared with t-tests (p<0.05). For the 47 patients identified,
age at time of surgery was 30.6 ± 14.9 years (range: 15.4 to 65.0 years). Follow-up
data were captured for 36 (73%) of the patients at 75 ± 37 weeks (range: 18 to 169
weeks) after surgery. Mean time to weightbearing was 4 ± 1 weeks (range: 1 to 7 weeks).
Patients returned to sport 14 ± 5 weeks after surgery (range: 8 to 41 weeks). Various
complications consisted of wound infection, superficial dehiscense and complex regional
pain syndrome (CRPS). The PROMIS, FAAM, and NRS patient outcome scores improved significantly
from preoperative to postoperative follow-up. Significant reduction in the radiographic
MCS postoperatively occurred in all patients. These findings suggest primary deltoid
repair when associated with ankle fracture to be a safe procedure and has the potential
of allowing early weight bearing and return to sports.
Level of Clinical Evidence
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Arthroscopic findings in acute fractures of the ankle.J Bone Joint Surg [Br]. 2000; 82: 345-351
- Which Ankle Fractures Require Syndesmotic Stabilization?.The Journal of Foot and Ankle Surgery. 2007; 46: 456-463https://doi.org/10.1053/J.JFAS.2007.08.009
- Tibio-talar stability in bimalleolar ankle fractures: a dynamic in vitro contact area study.Foot & ankle. 1991; 11: 222-227https://doi.org/10.1177/107110079101100407
- Use of a Flexible Implant and Bioabsorbable Anchor for Deltoid Rupture Repair in Bimalleolar Equivalent Weber B Ankle Fractures.The Journal of Foot and Ankle Surgery. 2015; 54: 513-516https://doi.org/10.1053/J.JFAS.2014.06.025
- Suture anchors for primary deltoid ligament repair associated with acute ankle fractures.Acta orthopaedica Belgica. 2019; 85: 387-391
- The Role of Deltoid Repair and Arthroscopy in Ankle Fractures.Clinics in sports medicine. 2020; 39: 733-743https://doi.org/10.1016/J.CSM.2020.06.003
- Clinical Study of Ankle Fracture Combined With Deltoid Ligament Injury: Repair or Not? A Retrospective, Comparative Study.The Journal of Foot and Ankle Surgery. 2020; 59: 648-652https://doi.org/10.1053/J.JFAS.2018.07.005
- Repair of the Acute Deltoid Ligament Complex Rupture Associated With Ankle Fractures: A Multicenter Clinical Study.The Journal of Foot and Ankle Surgery. 2015; 54: 198-202https://doi.org/10.1053/J.JFAS.2014.12.013
Woo SH, Bae SY, Chung HJ. Short-Term Results of a Ruptured Deltoid Ligament Repair During an Acute Ankle Fracture Fixation: https://doi-org.ezproxy3.lhl.uab.edu/101177/1071100717732383. 2017;39(1):35-45. doi:10.1177/1071100717732383
- Fractures of the distal part of the fibula with associated disruption of the deltoid ligament. Treatment without repair of the deltoid ligament.The Journal of bone and joint surgery American volume. 1987; 69: 1346-1352
- The deltoid ligament. An evaluation of need for surgical repair.Clinical Orthopaedics and Related Research. 1988; (Jan): 156-168
- Fracture-dislocation of the ankle with rupture of the deltoid ligament.Injury. 1988; 19: 59-61https://doi.org/10.1016/0020-1383(88)90071-X
- Rupture of the deltoid ligament in ankle fractures: should it be repaired?.Injury. 1989; 20: 39-41https://doi.org/10.1016/0020-1383(89)90043-0
- Deltoid Ligament Rupture in Ankle Fracture: Diagnosis and Management.The Journal of the American Academy of Orthopaedic Surgeons. 2019; 27: e648-e658https://doi.org/10.5435/JAAOS-D-18-00198
- Anatomic Ligament Repair Restores Ankle and Syndesmotic Rotational Stability as Much as Syndesmotic Screw Fixation.Journal of orthopaedic trauma. 2016; 30: e36-e40https://doi.org/10.1097/BOT.0000000000000427
- Deltoid ligament repair reduces and stabilizes the talus in unstable ankle fractures.Journal of orthopaedics. 2019; 17: 87-90https://doi.org/10.1016/J.JOR.2019.06.005
- Acute Deltoid Ligament Repair in Ankle Fractures: Five-year Follow-up.Clinics in podiatric medicine and surgery. 2020; 37: 295-304https://doi.org/10.1016/J.CPM.2019.12.004
- Repair of Acute Superficial Deltoid Complex Avulsion During Ankle Fracture Fixation in National Football League Players.Foot & ankle international. 2015; 36: 1272-1278https://doi.org/10.1177/1071100715593374
- Suture anchor repair for ruptured deltoid ligament in pronation ankle fractures.Current Orthopaedic Practice. 2017; 28: 459-464
Article info
Publication history
Publication stage
In Press Accepted ManuscriptFootnotes
This study was approved by Intermountain IRB and Sterling IRB: Intermountain Healthcare IRB
IRB Number: 1051840. Reference Number: 031177, Sterling IRB # 8261-NEWaldrop.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American College of Foot and Ankle Surgeons.
