Short-Term Results of a Ruptured Deltoid Ligament Repair During an Acute Ankle Fracture Fixation

Woo, Seung Hun; Bae, Su-Young; Chung, Hyung-Jin

doi:10.1177/1071100717732383

Cited by 63 publications

(82 citation statements)

References 41 publications

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“…Zhao et al [17] reported a significantly small MCS in the DL repair group postoperatively and at final follow-up (P = 0.03). Woo et al [16] reported a significant difference in the average final follow-up for MCS between the two groups (p = 0.001), but there was no difference seen in the immediate postoperative average MCS. Gu et al [15] found a significant reduction in the MCS between preoperative and postoperative radiographs in both groups at 1 year follow-up, with a greater improvement in the DL repair group (P = 0.02).…”

Section: Medial Clear Spacementioning

confidence: 96%

“…The AOFAS score was reported in all included studies. Gu et al [15] reported significantly better AOFAS scores after DL repair (P = 0.001); yet, in the two studies by Woo et al [16] and Zhao et al [17], the AOFAS scores were comparable in the two groups, with no statistical significance (P > 0.05).…”

Section: Functional Outcomementioning

confidence: 99%

“…Ankle fracture dislocations with isolated lateral malleolus fractures were included in the study of Gu et al [15]; after fixation of the lateral malleolus, a medial incision was made with repair of the DL using anchor sutures. Woo et al [16] included patients with SER or PER ankle injuries, with an isolated lateral malleolus fracture, after repairing the lateral malleolus plus/minus syndesmotic fixation, as indicated by the cotton test [18]; a medial incision was made and the DL was fixed with 1 or 2 anchor sutures in the medial malleolus, 5 mm lateral to the medial talus. Zhao et al [17] repaired the DL in SER, PER, and pronation-abduction injuries, after fixation of the lateral malleolus fractures, indicated posterior malleolus fractures and disrupted syndesmosis, as observed by intraoperative images.…”

Section: Surgical Techniquementioning

confidence: 99%

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

Salameh

Alhammoud

Alkhatib

et al. 2019

International Orthopaedics (SICOT)

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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.

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Section: Medial Clear Spacementioning

confidence: 96%

Section: Functional Outcomementioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

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

Salameh

Alhammoud

Alkhatib

et al. 2019

International Orthopaedics (SICOT)

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“…Recent studies have suggested that detecting and repairing deltoid ligament injury produces better results in ankle fractures with syndesmotic instability. 52,53 Finally, the number of patients included in this study was small, limiting the generalizability of the results. The small sample size also increases the difficulty of comparing the radiographic and clinical results according to the specific fracture type.…”

Section: Discussionmentioning

confidence: 98%

Reduction and fixation of anterior inferior tibiofibular ligament avulsion fracture without syndesmotic screw fixation in rotational ankle fracture

et al. 2019

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Objective We aimed to present the radiographic and functional outcomes of anatomical reduction and fixation of anterior inferior tibiofibular ligament (AITFL) avulsion fracture without syndesmotic screw fixation in rotational ankle fracture. Methods We retrospectively reviewed 66 consecutive patients with displaced malleolar fracture combined with AITFL avulsion fracture. We performed reduction and fixation for the AITFL avulsion fracture when syndesmotic instability was present after malleolar fracture fixation. A syndesmotic screw was inserted only when residual syndesmotic instability was present even after AITFL avulsion fracture fixation. The radiographic parameters were compared with those of the contralateral uninjured ankles. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were assessed 1 year postoperatively. Results Fifty-four patients showed syndesmotic instability after malleolar fracture fixation and underwent reduction and fixation for AITFL avulsion fracture. Among them, 45 (83.3%) patients achieved syndesmotic stability, while 9 (16.7%) patients with residual syndesmotic instability needed additional syndesmotic screw fixation. The postoperative radiographic parameters were not significantly different from those of the uninjured ankles. The mean AOFAS score was 94. Conclusion Reduction and fixation of AITFL avulsion fracture obviated the need for syndesmotic screw fixation in more than 80% of patients with AITFL avulsion fracture and syndesmotic instability.

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“…Estudos recentes sugerem que a reconstrução do LD promove recuperação funcional, alivia a dor e diminui o espaço livre medial (ELM). Outros estudos comparam tratamento conservador, reparo do LD e tratamento cirúrgico com ou sem reparo do LD (6)(7)(8)(9)(10)(11) .…”

Section: Introductionunclassified

Comparison of deltoid ligament repair and syndesmotic fixation in malleolar fractures

et al. 2019

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Introduction: The aims were to assess residual deltoid ligament instability after lateral malleolus osteosynthesis and to compare the outcomes of deltoid suture and syndesmotic fixation. Methods: A consecutive series of 65 eligible patients with a displaced or minimally displaced fibula fracture identified on a stress radiograph were prospectively enrolled. The patients were randomized into two groups, namely, group I (deltoid repair) and group II (syndesmotic fixation). We assessed the competence of the deltoid ligament intraoperatively using a manual stress test. Only the patients with residual medial instability (Medial Clear Space greater than 4 mm) were randomly assigned for treatment by deltoid ligament repair with anchor or syndesmotic fixation. Results: Of all the patients, 60 (92.2%) had positive preoperative manual stress test results. After fracture osteosynthesis, the test results were still positive in 13 (21.6%) patients, 8 (13.3%) patients from group I, both superficial and deep layers sutured with a bone anchor, and 5 patients (8.3%) from group II, stabilized with a syndesmotic 4-cortical screw. At the end of the surgery, a new manual stress test was performed, which proved stability in all the patients. The average follow-up period was 23.5 months. In groups I and II, the AOFAS scores were 95 and 93, the EQ-5D measures were 0.758 and 0.743, the visual analogue scale (VAS) scores were 16.7 and 19.2, and the Medial Clear Space values were 2.7 ± 0.5 mm and 2.6 ± 0.4 mm, respectively, without statistically significant differences. Conclusion: In 21.6% of cases, residual medial instability persisted after osteosynthesis of the lateral malleolus. The deltoid repair and syndesmotic fixation groups showed similar functional and radiological outcomes. Level of Evidence II; Therapeutic Studies; Prospective Comparative Study.

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Short-Term Results of a Ruptured Deltoid Ligament Repair During an Acute Ankle Fracture Fixation

Abstract: Level III, retrospective comparative case series.

Cited by 63 publications

References 41 publications

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

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

Reduction and fixation of anterior inferior tibiofibular ligament avulsion fracture without syndesmotic screw fixation in rotational ankle fracture

Comparison of deltoid ligament repair and syndesmotic fixation in malleolar fractures

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