Current Concepts in Treatment of Acute Deltoid Instability

Slullitel, Gastón; Calvi, Juan Pablo

doi:10.1016/j.fcl.2021.03.006

Cited by 3 publications

(5 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is no higher-level evidence for the need for DL repair if, after reduction and fixation of the fibula, the medial clear space is normal 65,66,80,81 . Open revision is indicated if interposition of the ligament prevents reduction or if there is gross medial instability following fibular fixation, as assessed with valgus stress 66,82 . There are reports on improved restoration of the medial clear space with DL repair in ankle fractures, but the clinical implications of these findings remain unclear 83-85 .…”

Section: Principles Of Treatmentmentioning

confidence: 99%

Maisonneuve Fractures of the Ankle

2022

View full text Add to dashboard Cite

Maisonneuve fractures (MFs), originally described as subcapital (high) fibular fractures with additional injury to the anterior and interosseous tibiofibular ligaments, display a variable injury pattern, ranging from stable to highly unstable fractures.The high incidence of associated fractures of the posterior malleolus, the medial malleolus, and the anterolateral distal tibia (the “anterior malleolus”) as well as the variable position of the fibula in the fibular notch (FN) warrant preoperative examination via computed tomography (CT).The main goal of treatment is anatomic reduction of the distal fibula into the FN, which requires prior reduction of displaced posterior malleolar fractures, if present, to restore the integrity of the FN.Open reduction of the distal fibula into the FN and fixation with 2 transsyndesmotic screws or fixation with a screw(s) and suture-button implant, under direct vision, on the lateral aspect of the ankle joint and anterior tibiofibular alignment are preferred over closed reduction to avoid sagittal or rotational malpositioning, which is associated with an inferior outcome.Intra- or postoperative 3D CT visualization is essential for assessment of the accuracy of the reduction of the distal fibula into the FN.

show abstract

Section: Principles Of Treatmentmentioning

confidence: 99%

Maisonneuve Fractures of the Ankle

2022

View full text Add to dashboard Cite

show abstract

“…Several studies have graded DL injuries based on the ALMC as follows: grade I (ligament stretching/thickening/striation loss), grade II (partial tear) and grade III (discontinuity/gap/complete disruption). Treatment strategies have been proposed based on these grades: non-operative treatment for grade I injuries and surgery for grade II and III injuries (17)(18)(19)(20)(21)(22). However, the accuracy of evaluating DL integrity by ALMC has varied from study to study.…”

Section: Discussionmentioning

confidence: 99%

“…2). Grade II or III injuries required surgical intervention (17)(18)(19)(20)(21)(22). ( 2) Bone marrow edema at ligament insertion (BMELI): BME, also known as a bone contusion or bone bruise, refers to the alteration of bone marrow signal on MR images, specifically an increase of signal intensity on T2-weighted images and weakened intensity on T1-weighted images (23)(24)(25).…”

Section: Mri Scan and Image Analysismentioning

confidence: 99%

Bone marrow edema at ligament insertion is an accurate MRI sign of deltoid ligament injury

Tong,

Li,

et al. 2023

Acta Radiol

View full text Add to dashboard Cite

Background Magnetic resonance imaging (MRI) is effective in diagnosing deltoid ligament (DL) injury but its sensitivity in chronic cases is low. Additional diagnostic signs are required to reduce the risk of a false negative diagnosis. Purpose To evaluate the added diagnostic value of bone marrow edema at the ligament insertion (BMELI) of DL to the MRI assessment of chronic DL injury. Material and Methods One hundred patients who consecutively came to our institution between November 2018 and December 2021 and underwent arthroscopic surgery for chronic ankle instability (CAI) were enrolled in the present study. Preoperative MR images were retrospectively reviewed by two orthopedic surgeons to evaluate the sensitivity, specificity and interobserver reliability of three MRI signs in diagnosing chronic DL injury, namely, abnormal ligamentous morphological characteristics (ALMC), BMELI and medial clear space (MCS). Results Taking arthroscopy as the reference standard, there were 34 patients with and 66 without DL injury. ALMC had 64.71% (22/34; 46.47–79.70) sensitivity and 83.33% (55/66; 71.71–91.00) specificity, BMELI had 70.59% (24/34; 52.33–84.29) sensitivity and 95.45% (63/66; 86.44–98.82) specificity and MCS had 26.47% (9/34; 13.51–44.65) sensitivity and 92.42% (61/66; 82.50–97.18) specificity. Compared with ALMC, BMELI had similar efficacy in superficial cases ( P = 0.06) and greater efficacy in deep cases ( P = 0.04). All three signs showed good interobserver agreement (kappa values all above 0.7). Conclusion BMELI can reliably indicate concomitant injury to the DL in CAI patients. Using BMELI as a sign of chronic DL injury when ALMC is unclear may reduce the risk of a false negative diagnosis.

show abstract

“…Medial ankle sprains have a relatively low incidence, accounting for 5% of ankle ligamentous injuries. In this scenario, the deltoid ligament complex is the most frequently damaged structure (1) ; however, clinically determining which structures are injured is not an easy task. Clinical diagnosis is often insufficient due to poorly specific symptoms, such as pain, swelling, tenderness, instability, and ecchymosis (2) .…”

Section: Introductionmentioning

confidence: 99%

“…Clinical diagnosis is often insufficient due to poorly specific symptoms, such as pain, swelling, tenderness, instability, and ecchymosis (2) . Within this scope, the intimate anatomic relationship between the spring ligament, the posterior tibial tendon (PTT), or the flexor retinaculum and the superficial layer of the medial collateral ligament warrant further evaluation (1) .…”

Section: Introductionmentioning

confidence: 99%

Posterior tibial tendon dislocation after a medial ankle sprain: a case report

et al. 2022

View full text Add to dashboard Cite

Medial ankle sprains have a very low incidence (5% of ankle ligament injuries), and most of the time, the first structure involved is the deltoid ligament complex. However, other structures, such as the spring ligament, posterior tibial tendon, and flexor retinaculum, can also get damaged. A 32-year-old man who had an ankle sprain while performing sports activities showed magnetic resonance imaging findings compatible with a detachment of the flexor retinaculum and medial dislocation of the posterior tibial tendon. Surgical intervention was suggested to this patient; deepening of the medial retromalleolar groove and reattaching of the retinaculum were performed. It is very important to consider this rare injury after a medial ankle sprain and to think out of the box, not always assuming a deltoid ligament lesion. Level of Evidence V; Therapeutic Studies; Expert Opinion.

show abstract

Current Concepts in Treatment of Acute Deltoid Instability

Cited by 3 publications

References 34 publications

Maisonneuve Fractures of the Ankle

Maisonneuve Fractures of the Ankle

Bone marrow edema at ligament insertion is an accurate MRI sign of deltoid ligament injury

Posterior tibial tendon dislocation after a medial ankle sprain: a case report

Contact Info

Product

Resources

About