Deltoid ligament repair versus trans-syndesmotic fixation for bimalleolar equivalent ankle fractures

Whitlock, Keith; LaRose, Micaela; Barber, Helena; Fletcher, Amanda N.; Cunningham, D. J.; Menken, Luke G.; Yoon, Richard S.; Gage, Mark J.

doi:10.1016/j.injury.2022.03.063

Cited by 9 publications

(9 citation statements)

References 43 publications

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“…No significant difference was found in functional scores between the repair group and the control group at the 2‐year follow‐up. First, it might be due to a short‐term follow‐up in these combined injuries [35]. Moreover, the superficial DL was repaired in the present study.…”

Section: Discussionmentioning

confidence: 92%

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

Xue

Tong

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose To compare the clinical and magnetic resonance imaging (MRI) results after arthroscopic deltoid ligament (DL) repair versus DL nonrepair in patients with rotational ankle instability. Methods All patients with rotational ankle instability were enrolled in this retrospective cohort study. Clinical evaluation was performed by the American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson Ankle Functional Score (KAFS), and Tegner activity score preoperatively and at a minimum follow-up of 2 years. MRI at follow-up was performed to evaluate the DL morphology. Results A total of 50 patients were enrolled in this study. Among them, 24 patients received DL repair (the repair group), whereas 26 patients did not (the nonrepair group). No signiicant diference was found in the AOFAS score (98 ± 4 vs. 97 ± 4; n.s.), KAFS (94 ± 7 vs. 93 ± 9; n.s.), or Tegner activity score (5 ± 2 vs. 5 ± 1; n.s.) between the repair group and the nonrepair group at the inal follow-up. However, the repair group had a signiicantly shorter return-to-sport time than the nonrepair group (4.6 ± 1.6 mo vs. 6.0 ± 2.5 mo; p = 0.03). Comparison of the postoperative deltoid ligament showed that the repair group had a lower signal intensity than the nonrepair group. Conclusion Arthroscopic treatment of rotational ankle instability revealed good to excellent clinical results. However, patients who underwent DL repair had a signiicantly earlier return to sports as well as a lower signal intensity of DL than those who did not undergo DL repair. Level of evidence Level III.

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Section: Discussionmentioning

confidence: 92%

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

Xue

Tong

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…The eligibility criteria included (1) any trial design, (2) studies that evaluated external rotation or gravity stress tests or hook or tap tests for the diagnosis of deltoid ligament and/ or syndesmosis injury in patients older than 14 years with acute ankle fracture, (3) studies that compared the results of the stress test with specified reference standards, and (4) studies that reported data which enabled the calculation of the number of true-positive (TP), true-negative (TN), falsepositive (FP), and false-negative (FN) outcomes. The exclusion criteria included (1) studies without descriptions for stress methods or reference standards; (2) prognostic studies without diagnostic accuracy data; (3) in cases where 2 included studies have patient cohort overlap, the study with the lower number of participants was excluded; (4) in studies in which only a part of participants fulfilled the inclusion criteria, the rest participants were excluded; (5) letters, technique tips, reviews, case series studies with ,10 participants, cadaveric studies, or studies using animal models; and (6) non-English articles or those for which no full text is available.…”

Section: Eligibility Criteriamentioning

confidence: 99%

“…The deltoid ligament and tibiofibular syndesmosis are 2 main soft-tissue structures with reciprocal contribution to ankle mortise stability. [2][3][4] A systemic review reported that 60.9% of the patients with ankle fracture had deltoid ligament injury and 77.9% of the patients with ankle fracture had syndesmosis injury. 5 Most studies recommend syndesmotic stabilization if syndesmosis widening occurs after fixing the bony structure.…”

Section: Introductionmentioning

confidence: 99%

Stress tests for deltoid ligament and syndesmosis injury in patients with ankle fracture: a systemic review with meta-analysis

Cao,

Wang,

Chen

et al. 2023

Journal of Orthopaedic Trauma

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Objectives: To determine the diagnostic accuracy of various stress tests for deltoid ligament and syndesmosis injury in patients with ankle fracture. Data Sources: A systemic literature search was conducted in the Medline, Embase, and Cochrane Library databases to identify studies published from January 1990 to August 2022. Study selection: Studies that evaluated external rotation or gravity stress tests, or hook or tap tests for the diagnosis of deltoid ligament or syndesmosis injury were included. Data Extraction: Authors, publication years, study design, index tests, reference standards, demographic features of participants, reliability and the numbers of true positive, true negative, false positive, and false negative subjects were extracted from 14 included studies. Article quality was assessed through the revised Quality Assessment of Diagnostic Accuracy Studies tool. Data synthesis: The pooled sensitivity and specificity of each index test for each structure were calculated with a random-effects model using the extracted data of true positive, true negative, false positive, and false negative outcomes in all relevant studies. The overall diagnostic performance of the different index tests for different structures was determined with the estimation of the area under the curve using the summary receiver operating characteristics curve. Conclusions: The gravity stress test and the tap test exhibited high sensitivity and specificity in diagnosing deltoid ligament injury. The hook test has relatively high accuracy in diagnosing syndesmosis injury. Further studies with large sample sizes are warranted to confirm the results of this review. Levels of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…[7,8] A deep deltoid ligament injury is equal to a medial malleolus fracture, when complicated with lateral malleolus fracture. [9,10] Either medial malleolus fracture or deep deltoid ligament rupture could lead to widen the medial articular space and thus seriously affect the stability of ankle, which usually needs surgical fixation to avoid posttraumatic osteoarthritis. [11,12] It is generally agreed that medial malleolus fracture and deltoid ligament rupture could not occur simultaneously.…”

Section: Introductionmentioning

confidence: 99%

Could medial malleolus fracture be combined with deltoid ligament injury?: A rare case report

Li,

Liu,

Dong

2024

Medicine

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Rationale: Medial malleolus injuries mainly comprise of fractures and deltoid ligament ruptures. Medial malleolus fractures, as a kind of common ankle fractures, could occur separately or be accompanied by lateral and posterior malleolus fractures. It is generally agreed that medial malleolus fracture and deltoid ligament rupture could not occur simultaneously. Patient concerns: In our study, we report a case of 36 year-old man diagnosed with trimalleolar fracture accompanying ankle dislocation initially. The patient was admitted to our hospital due to traffic accident. Diagnosis: The patient was diagnosed with trimalleolar fracture accompanying ankle dislocation initially. We missed the diagnosis of accompanied deltoid ligament due to the arthralgia of medial ankle and the widened medial articular space in X-ray after operation. Intervention: As we missed the diagnosis of accompanied deltoid ligament, we only selected open reduction and internal fixation for trimalleolar fracture at first. After we realized the existence of deltoid ligament rupture, the patient refuse further diagnosis and treatment in our hospital. Outcomes: During the rehabilitation exercise, the patient had medial arthralgia in his right ankle. He complained it and refuse further diagnosis and treatment in our hospital. Lessons: The newfound injury pattern, medial malleolus fracture accompanying deltoid ligament rupture, has not been reported in previous studies. The injury pattern needs further researches to explore the mechanism and it should be taken seriously in clinical practice.

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Deltoid ligament repair versus trans-syndesmotic fixation for bimalleolar equivalent ankle fractures

Cited by 9 publications

References 43 publications

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

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

Stress tests for deltoid ligament and syndesmosis injury in patients with ankle fracture: a systemic review with meta-analysis

Could medial malleolus fracture be combined with deltoid ligament injury?: A rare case report

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