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

Abstract

Background Rupture of the deltoid ligament (DL) in acute ankle fracture is very common. However, there is still insufficient evidence on whether to repair the DL in acute ankle fracture. Therefore, a systematic review and meta-analysis of comparative studies was performed to report the outcome of DL repair in acute ankle fracture. Methods The PubMed, Cochrane Library, EMBASE and Web of Science databases were searched from the inception dates to October 31, 2020, for comparative studies. The methodological quality was evaluated based on the risk-of-bias tool of the Cochrane Collaboration for Randomized Controlled Trials (RCTs) or the Risk-of-Bias Assessment Tool for Non-randomized Studies (RoBANS). The post-operative medial clear space (MCS), final MCS, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) score and incidence of complications were analysed. Results A total of 8 comparative studies involving 388 participants who suffered Weber type B or C ankle fractures were included in this meta-analysis. The results showed that the post-operative MCS, final MCS, AOFAS score and rate of complications were statistically superior in the DL repair group. For the VAS score, there was no significant difference between the DL repair group and the DL non-repair group. Conclusions In this meta-analysis of comparative studies, DL repair offered great advantages in terms of the post-operative MCS, final MCS, AOFAS score and rate of complications compared with non-repair. The repair of the DL in patients with acute ankle fractures might be beneficial to ankle joint stability and assist in improving the quality of ankle reduction. More high-quality and prospective studies with long follow-up durations are needed to further demonstrate the superiority of DL repair over non-repair.

Simultaneous Single-Graft Tibiofibular Syndesmosis and Deltoid Ligament Reconstruction in Chronic Instability: Technical Tip

“…Thus, its repair has been advocated in patients with increased syndesmosis diastasis (CMS > 4 mm) and complete DL rupture offering significant advantages in postoperative CMS, final CMS, AOFAS score, and rate of complications. 3…”

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

“…To date, the appropriate treatment for DL injury is still controversial in ankle sprains [3, 13, 16, 30]. DL injury in cases of ankle fracture can be treated via conservative management with good results, and no chronic medial instability was observed [6, 17, 27, 28].…”

Arthroscopically Assisted Reduction and Fixation of Deltoid Ligament Avulsion Fracture From Medial Malleolus

“…The deltoid ligament is frequently ruptured in ankle fractures. 1 , 3 , 4 , 5 The ligament plays an important role in maintaining concentric talus reduction within the ankle mortise and stabilizes the ankle joint against eversion, external rotation, and plantar flexion forces. 1 , 6 , 7 , 8 However, there is no consensus on the optimal treatment of ruptured deltoid ligament in bimalleolar equivalent ankle fractures, and there is no evidence proving superiority of suturing the deltoid ligament in all ruptures.…”

“… 1 , 6 , 7 , 8 However, there is no consensus on the optimal treatment of ruptured deltoid ligament in bimalleolar equivalent ankle fractures, and there is no evidence proving superiority of suturing the deltoid ligament in all ruptures. 1 , 2 , 4 , 5 , 6 , 7 , 9 Deltoid ligament repair may be indicated in bimalleolar equivalent fractures with extensive capsuloligamentous damage, combined syndesmotic and deltoid insufficiency, or multiligamentous/multidirectional instability, especially in heavier patients with greater mechanical requirements. 6 , 7 This can be manifested as persistent external rotation or valgus instability after anatomic fibula fixation.…”

“… 10 In this case, deltoid ligament repair enhances ankle stability and improves the quality of MCS and ankle reduction. 1 , 2 , 5 , 8 If the deltoid ligament rupture is not repaired, retraction of the ligament with subsequent healing in a nonanatomic position may cause ankle instability, persistent medial gutter pain, and risk of early traumatic arthritis of the ankle joint. 4 , 7 , 11 , 12 Persistent widened MCS after anatomical fibula and syndesmosis fixation can be indicative of interposition either of the deltoid ligament, posterior tibial tendon or loose bodies, and medial exploration and deltoid ligament repair also is indicated.…”