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

Salameh, Motasem; Alhammoud, Abduljabbar; Alkhatib, Nedal; Attia, Ahmed Khalil; Mekhaimar, Mohamed M.; D’Hooghe, Pieter; Mahmoud, Karim

doi:10.1007/s00264-019-04416-9

Cited by 35 publications

(28 citation statements)

References 24 publications

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“…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.…”

Section: Plos Onesupporting

confidence: 81%

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

Guo

Lin²,

Chen

et al. 2021

PLoS ONE

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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.

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Section: Plos Onesupporting

confidence: 81%

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

Guo

Lin²,

Chen

et al. 2021

PLoS ONE

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Background Ankle-subtalar joint complex instability is not uncommonly presented in the clinic, but symptoms and signs similar to other conditions can easily lead to its misdiagnosis. Due to the lack of appropriate animal models, research on ankle-subtalar joint complex instability is limited. The aims of the present study were to establish an animal model of ankle-subtalar joint complex instability in mice and to explore its relationship with post-traumatic osteoarthritis (PTOA). Methods Twenty-one male C57BL/6J mice were randomly divided into three groups: SHAM group (sham surgery group), transected cervical ligament + anterior talofibular ligament (CL+ATFL) group, and transected cervical ligament + deltoid ligament (CL+DL) group. Two weeks after surgery, all mice underwent cage running training. Balance beam and gait tests were used to evaluate the changes in self-movement in the mice after ankle-subtalar ligament injury. Micro-CT and histological staining were used to evaluate the progress of PTOA. Results Compared with the SHAM group, balance and gait were affected in the ligament transection group. Twelve weeks after surgery, the time required to cross the balance beam in the CL+ATFL group was 35.1% longer and the mice slipped 3.6-fold more often than before surgery, and the mean step length on the right side was 7.2% smaller than that in the SHAM group. The time required to cross the balance beam in the CL+DL group was 32.1% longer and the mice slipped 3-fold more often than prior to surgery, and the average step length on the right side was 5.6% smaller than that in the SHAM group. CT images indicated that 28.6% of the mice in the CL+DL group displayed dislocation of the talus. Tissue staining suggested that articular cartilage degeneration occurred in mice with ligament transection 12 weeks after surgery. Conclusions Transected mice in the CL+ATFL and CL+DL groups displayed mechanical instability of the ankle-subtalar joint complex, and some mice in the CL+DL group also suffered from talus dislocation due to ligament injury leading to loss of stability of the bone structure. In addition, as time progressed, the articular cartilage displayed degenerative changes, which affected the ability of animals to move normally.

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“…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.…”

Section: The Deltoid Ligament Dilemma: To Repair or Not To Repair?mentioning

confidence: 98%

Acute foot and ankle injuries and time return to sport

Thevendran

Kadakia

Giza

et al. 2021

SICOT-J

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Foot and ankle sports injuries encompass a wide spectrum of conditions from simple contusions or sprains that resolve within days to more severe injuries that change the trajectory of an athlete’s sporting career. If missed, severe injuries could lead to prolonged absence from the sport and therefore a catastrophic impact on future performance. In this article, we discuss the presentation of the commonest foot and ankle sports injuries and share recent evidence to support an accurate diagnosis and best management practice.

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

Cited by 35 publications

References 24 publications

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

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

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

Acute foot and ankle injuries and time return to sport

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