Abstract:Background: The deltoid ligament (DL) is a strong triangle-shaped ligament with a complex fascicular arrangement. Understanding the morphological and/or functional typing of the DL structure is hindered by a paucity of clear, quantitative, and reproducible data and is further complicated by inconsistent terminology use. The aim of this work was to describe different components of the DL using strict identification criteria.Methods: Thirty embalmed cadaveric ankles of both sides were dissected on all sides and … Show more
“…3 Finally, the deltoid is partially covered by the tibialis posterior tendon, of which the tendon sheath forms a part of the deltoid fibers, covering the posterior and middle part. This is comparable to the peroneal tendon sheath covering the lateral ligaments 7 .…”
Section: Deltoid Ligament Anatomymentioning
confidence: 73%
“…3 Finally, the deltoid is partially covered by the tibialis posterior tendon, of which the tendon sheath forms a part of the deltoid fibers, covering the posterior and middle part. This is comparable to the peroneal tendon sheath covering the lateral ligaments 7 .Figure 1.Schematic depiction of multiple segments of the deltoid ligament. The left figure depicts the deep part of the deltoid ligament.…”
The deltoid ligament is the primary stabilizer of the medial side of the ankle joint. It is a complex structure with an origin at the medial malleolus from where it spreads fan shaped distally with an insertion into the medial side of the talus, calcaneus and navicular bone. This chapter gives an overview of the anatomy, function, and pathology of the deltoid ligament. The deltoid ligament can become insufficient as a result of an ankle injury or prolonged strain. In the acute setting, deltoid insufficiency often coincides with multi ligament injury the ankle joint; syndesmosis injury, or ankle fractures. Management in the acute phase remains a subject of debate. Some orthopedic surgeons have a tendency towards repair, whereas most trauma surgeons often treat the deltoid nonoperatively. In the chronic setting the ligament complex is often elongated as a result of prolonged strain. It often coexists with a hindfoot valgus, as is the case in planovalgus feet. In such a case a realignment procedure should be combined with the deltoid repair.
“…3 Finally, the deltoid is partially covered by the tibialis posterior tendon, of which the tendon sheath forms a part of the deltoid fibers, covering the posterior and middle part. This is comparable to the peroneal tendon sheath covering the lateral ligaments 7 .…”
Section: Deltoid Ligament Anatomymentioning
confidence: 73%
“…3 Finally, the deltoid is partially covered by the tibialis posterior tendon, of which the tendon sheath forms a part of the deltoid fibers, covering the posterior and middle part. This is comparable to the peroneal tendon sheath covering the lateral ligaments 7 .Figure 1.Schematic depiction of multiple segments of the deltoid ligament. The left figure depicts the deep part of the deltoid ligament.…”
The deltoid ligament is the primary stabilizer of the medial side of the ankle joint. It is a complex structure with an origin at the medial malleolus from where it spreads fan shaped distally with an insertion into the medial side of the talus, calcaneus and navicular bone. This chapter gives an overview of the anatomy, function, and pathology of the deltoid ligament. The deltoid ligament can become insufficient as a result of an ankle injury or prolonged strain. In the acute setting, deltoid insufficiency often coincides with multi ligament injury the ankle joint; syndesmosis injury, or ankle fractures. Management in the acute phase remains a subject of debate. Some orthopedic surgeons have a tendency towards repair, whereas most trauma surgeons often treat the deltoid nonoperatively. In the chronic setting the ligament complex is often elongated as a result of prolonged strain. It often coexists with a hindfoot valgus, as is the case in planovalgus feet. In such a case a realignment procedure should be combined with the deltoid repair.
“…The deltoid ligament can be split into superficial and deep components, of which it has been found that the deep, rather than superficial, strata confer mechanical stability. The deep component has a specific and reproducible arrangement of fibers in a distinct three-leaf fan-like pattern consisting of the deep anterior tibio-talar ligament, deep intermediate tibio-talar ligament, and the posterior leaf -the deep posterior tibiotalar ligament [4] (Figure 1). Further anatomical and cadaveric biomechanical studies demonstrated that it was specifically the posterior third fibers or RAD that provide this stability in relation to talar shift, tilt, and rotation [5].…”
The deltoid ligament plays a key role in ankle stability. Ankle fractures involving the medial ligamentous complex are evaluated on the basis of medial-sided tenderness and the Ottawa ankle rules. Evolution in our understanding of this ligament over the last three decades has shown that, within this medial ligamentous complex, it is the deep deltoid ligament that confers mechanical stability. The latest evolution in this understanding, and the learning point of this report, is that only a distinct component of the deep deltoid ligament - specifically the discreet posterior third - the rear attachment of the deep deltoid ligament (RAD) - confers mechanical value. The RAD is responsible for providing the medial ligamentous component of ankle stability - specifically talar shift, tilt, and importantly rotational stability. This knowledge is of key importance in the assessment and management of ankle fractures with associated deltoid ligament injuries. In this technical report, we highlight the biomechanical contribution of the RAD, which will help surgeons and physiotherapists to accurately manage ankle injuries.
PurposeThe medial collateral ligament of the ankle, or deltoid ligament, can be injured in up to 40% of patients who sustain an ankle inversion sprain. Reporting injuries of the deltoid ligament is not easy due to confusion in the current anatomical descriptions, with up to 16 fascicles described, with variable frequencies. The purpose of this study was to clarify the anatomy of the deltoid ligament.MethodsThirty‐two fresh‐frozen ankle specimens were used for this study. Careful dissection was undergone until full visualization of the deltoid ligament was achieved and measurements taken.ResultsThe deltoid ligament was found to have four constant fascicles in two layers. The superficial layer consists of the tibionavicular, tibiospring and tibiocalcaneal fascicles, while the deep layer consists of the tibiotalar fascicle. Measurements of these fascicles are given in detail. The tibiotalar fascicle and the anterior part of the tibionavicular fascicle were found to be intra‐articular structures.ConclusionThe deltoid ligament has a constant number of fascicles divided into a superficial and a deep layer. This clarification of the anatomy and terminology of the deltoid ligament and its fascicles will help clinical view, diagnosis and (interdoctor)communication and treatment. The ligamentous fibres of the deep layer, as well as the anterior fibres of the superficial layer (tibionavicular fascicle) are intra‐articular, which could negatively impact its healing capacity, explaining chronicity of these types of injuries.Level of EvidenceNot applicable (cadaveric study).
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