Outcome of primary deltoid ligament repair in acute ankle fractures: a meta-analysis of comparative studies

Abstract

Purpose The indications of deltoid ligament repair in ankle injuries with widened medial clear space in the absence of medial malleolus fracture remain controversial. Many authors reported no difference in long-term functional outcomes, while others stated that persistent medial clear space widening and malreduction are higher when deltoid ligaments went without repair. This meta-analysis aims to report the current published evidence about the outcomes of deltoid ligament repair in ankle fractures. Methods Several databases were searched through May 2018 for comparative studies. The primary outcome was the medial clear space correction, while secondary outcomes included maintenance of medial clear space reduction, pain scores, functional outcome, and total complications if any. Three comparative studies met the inclusion criteria for the meta-analysis. The analysis included a total of 192 patients, 81 in the deltoid ligament repair group and 111 in the non-repair group. Results The medial clear space correction and maintenance of the said correction on final follow-up radiographs were superior in the deltoid ligament repair group. Although the pain scores were better in the repair group at the final follow-up, this did not result in a better functional outcome, with similar total complication rates. Conclusion In conclusion, those who had their deltoid ligament repaired had superior early and late radiological correction of the medial clear space, an indicator of the quality of ankle reduction with better pain scores. However, no differences in the functional outcome and complications rate were reported.

Comparison of deltoid ligament repair and non-repair in acute ankle fracture: A meta-analysis of comparative studies

“…Woo et al [23] noted that without DL repair, patients occasionally suffered from persistent medial pain around the DL even after anatomical healing. Some authors believe DL repair will prolong the operation and increase the incidence of wound-related complications [32], and our data analysis shows the same results.…”

A mouse model of ankle-subtalar joint complex instability induced post-traumatic osteoarthritis

“…In addition, a number of studies have shown that approximately 40% of patients treated for ankle instability display DL injury. Although some researchers continue to dispute whether such DL injuries should be repaired, some believe that the quality of life of patients is unaffected in the absence of a repair [ 31 , 32 ]. Therefore, we aimed in the present study to explore whether joint injury from transection of the CL+ATFL or CL+DL ligaments affected ankle-subtalar joint complex instability, ultimately reducing the quality of life of a patient, and to provide an updated reference for clinical treatments of ankle-subtalar joint complex instability.…”

Acute foot and ankle injuries and time return to sport

“…A recent review available on this topic including only 3 prospective studies (1 level 2, 2 level 3 studies) with small sample size, did not prove the superiority of additional medial repair [10]. An important part of this discussion may be the switch from screw fixation to flexible systems.…”