Deltoid ligament (DL) repair produced better results than DL nonrepair for the treatment for rotational ankle instability

Li, Hong; Xue, Xiao’ao; Tong, Jiahui; Liu, Hongyun; Hua, Yinghui

doi:10.1007/s00167-022-07169-y

Cited by 7 publications

(2 citation statements)

References 39 publications

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“…Although recent studies showed no differences in long term functional outcomes when the deltoid ligament was repaired (13), the deltoid ligament repair may lead to better ankle stability (11,14). Thus, more and more researchers believe that surgical repair of deltoid ligament rupture is the first choice to maintain the stability of ankle joint and prevent the occurrence of valgus and extransion of talus and long-term traumatic arthritis (15)(16)(17). In the present study, good functional outcomes were achieved and technique safety was observed based on the results of AOFAS, VAS, and ankle ROM.…”

Section: Discussionmentioning

confidence: 99%

Repair of deep deltoid ligament ruptures near the medial malleolar attachment or midsubstance rupture by using suture anchors into the talus combined with the transosseous suture in the medial malleolar

Liang,

Zhou,

Jiang

et al. 2024

Front. Surg.

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PurposeFor deep deltoid ligament ruptures near the medial malleolar attachment, anchors were usually placed at the posterior colliculus and intercollicular groove. However, this procedure usually requires a prolonged surgical incision to fully expose the deep deltoid ligament, causing more trauma. In order to reduce surgical trauma, we explored the treatment outcomes of suture anchor into the talus combined with transosseous suture in the medial malleolar for the treatment of deep deltoid ligament ruptures near the medial malleolar attachment or midsubstance rupture.Patients and methodsThis is a retrospective study of patients who received suture anchor into the talus combined with transosseous suture in the medial malleolar for repairing deltoid ligament ruptures near the medial malleolar attachment or midsubstance rupture. The outcome measures include the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS), and the active range of motion (ROM) of the ankle at the final follow-up visit after surgery. Medial malleolus gap was evaluated by radiographic examination.ResultsThis study included 64 patients. The mean follow-up time was 36.3 ± 15.2 months. There were 43 patients with injuries on the medial malleolar side, and 21 cases on the midsubstance. The average AOFAS and VAS were 87.5 ± 4.9 and 0.7 ± 0.5, respectively. No significance in medial malleolus gap between the contralateral side and affected side was observed.ConclusionFor deltoid ligament ruptures near the medial malleolar attachment or midsubstance rupture, suture anchor into the talus combined with transosseous suture in the medial malleolar yields good clinical effect and outcome, is an optimal management of ankle syndesmosis injuries.

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Section: Discussionmentioning

confidence: 99%

Repair of deep deltoid ligament ruptures near the medial malleolar attachment or midsubstance rupture by using suture anchors into the talus combined with the transosseous suture in the medial malleolar

Liang,

Zhou,

Jiang

et al. 2024

Front. Surg.

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“…A similar lack of consensus exists on the best strategy for treating DL injuries. Vega et al introduced a surgical technique for repairing the anterior fibers of the deltoid ligament using a single anchor and non-absorbable sutures ( Vega et al, 2020 ), and Li et al detailed a method for repairing the deep fibers in the DL using a similar approach ( Li et al, 2023 ). Higashiyama et al used autologous tendon grafts for anterior tibiotalar ligament (ATTL) reconstruction ( Higashiyama et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Investigation into the effect of deltoid ligament injury on rotational ankle instability using a three-dimensional ankle finite element model

Li,

Tong,

Wang

et al. 2024

Front. Bioeng. Biotechnol.

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BackgroundInjury to the lateral collateral ligament of the ankle may cause ankle instability and, when combined with deltoid ligament (DL) injury, may lead to a more complex situation known as rotational ankle instability (RAI). It is unclear how DL rupture interferes with the mechanical function of an ankle joint with RAI.PurposeTo study the influence of DL injury on the biomechanical function of the ankle joint.MethodsA comprehensive finite element model of an ankle joint, incorporating detailed ligaments, was developed from MRI scans of an adult female. A range of ligament injury scenarios were simulated in the ankle joint model, which was then subjected to a static standing load of 300 N and a 1.5 Nm internal and external rotation torque. The analysis focused on comparing the distribution and peak values of von Mises stress in the articular cartilages of both the tibia and talus and measuring the talus rotation angle and contact area of the talocrural joint.ResultsThe dimensions and location of insertion points of ligaments in the finite element ankle model were adopted from previous anatomical research and dissection studies. The anterior drawer distance in the finite element model was within 6.5% of the anatomical range, and the talus tilt angle was within 3% of anatomical results. During static standing, a combined rupture of the anterior talofibular ligament (ATFL) and anterior tibiotalar ligament (ATTL) generates new stress concentrations on the talus cartilage, which markedly increases the joint contact area and stress on the cartilage. During static standing with external rotation, the anterior talofibular ligament and anterior tibiotalar ligament ruptured the ankle’s rotational angle by 21.8% compared to an intact joint. In contrast, static standing with internal rotation led to a similar increase in stress and a nearly 2.5 times increase in the talus rotational angle.ConclusionInjury to the DL altered the stress distribution in the tibiotalar joint and increased the talus rotation angle when subjected to a rotational torque, which may increase the risk of RAI. When treating RAI, it is essential to address not only multi-band DL injuries but also single-band deep DL injuries, especially those affecting the ATTL.

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Arthroscopic treatment of ankle multiligamentous injuries provides similar clinical outcomes to the treatment of isolated lateral ligament injury at the 2‐year follow‐up

Guelfi,

Vega,

Dalmau‐Pastor

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeRotational ankle instability is a multiligamentous injury defined as an overload injury of the deltoid ligament caused by a long‐standing injury of the lateral collateral ligament in patients affected by chronic ankle instability. The purpose of the study was to compare the clinical outcomes of combined arthroscopic repair of lateral and medial ankle ligaments for rotational ankle instability versus isolated arthroscopic lateral ligament repair for lateral ankle instability at 2 years' follow‐up.MethodsBetween 2019 and 2021, 108 patients with chronic ankle instability were consecutively treated by arthroscopy. Of this group, 83 patients (77%) [median age: 26 (range, 14–77) years] underwent an isolated all‐inside lateral ligament repair for lateral ankle instability (group A). In the remaining 25 patients (23%) [median age: 27 (range, 17–58) years], rotational ankle instability was clinically suspected and confirmed during arthroscopy; thus, a combined all‐inside repair of lateral and medial ligaments was performed (group B). The same postoperative protocol was utilised for both groups. Patients were prospectively evaluated before surgery, at 3, 6, 12 and 24 months with Foot Functional Index (FFI) score, visual analogue scale (VAS) and Foot and Ankle Ability Measure–Sports subscale (FAAM‐SS). At the latest follow‐up, the satisfaction rate and complications were also recorded.ResultsIn both groups, FFI, VAS and FAAM‐SS scores significantly improved compared to preoperative values (p < 0.001). In addition, according to all the scores evaluated, there was no significative difference (n.s) between groups at the final follow‐up or at any of the intermediate follow‐up. No major complications were observed in both groups.ConclusionsArthroscopic ligament repair in case of ankle multiligamentous injuries, such as in rotational ankle instability, provides excellent clinical outcomes and is comparable to isolated lateral ligament repair at 2 years' follow‐up. Therefore, when treating ankle instability, arthroscopic repair of each and every ligament that appears injured provides the best potential outcomes and is the recommended treatment.Level of EvidenceLevel II, prospective comparative.

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Deltoid ligament (DL) repair produced better results than DL nonrepair for the treatment for rotational ankle instability

Cited by 7 publications

References 39 publications

Repair of deep deltoid ligament ruptures near the medial malleolar attachment or midsubstance rupture by using suture anchors into the talus combined with the transosseous suture in the medial malleolar

Repair of deep deltoid ligament ruptures near the medial malleolar attachment or midsubstance rupture by using suture anchors into the talus combined with the transosseous suture in the medial malleolar

Investigation into the effect of deltoid ligament injury on rotational ankle instability using a three-dimensional ankle finite element model

Arthroscopic treatment of ankle multiligamentous injuries provides similar clinical outcomes to the treatment of isolated lateral ligament injury at the 2‐year follow‐up

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