Repair of Acute Superficial Deltoid Complex Avulsion During Ankle Fracture Fixation in National Football League Players

Hsu, Andrew R.; Lareau, Craig R.; Anderson, Robert B.

doi:10.1177/1071100715593374

Cited by 67 publications

(60 citation statements)

References 21 publications

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“…However, some recent and well-done studies suggested a better outcome after DL repair [15-17, 26, 27]. Hsu et al [27], in his series of 14 National Football League (NFL) players with ankle fractures, found that open DL repair allowed return to play with no complications at 12-month follow-up. In another study by Yu et al [26], DL repair in 106 patients with acute ankle fractures resulted in satisfactory functional outcomes, with no clinical or radiological evidence of post-traumatic ankle arthritis in fractures managed with DL repair, as observed at an average of 27-month follow-up.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…Numerous ligament reconstruction techniques have been proposed; however, clear indications for operative repair have not yet been well established. Some studies have shown that repair of the ruptured ligament is beneficial and can produce satisfactory results [11,12,14,20]. By contrast, other studies showed repair of the deltoid ligament to be unnecessary [1,4,10,17,21].…”

Section: Discussionmentioning

confidence: 99%

“…There are few reports in terms of detailed biomechanics of the deltoid ligament [11,16,18,19,20], and no reports have measured the biomechanics of each ligamentous band, due to the difficulty in inserting sensors into the narrow ligaments. The paucity of biomechanics data regarding each ligamentous band may have contributed to less reliable results of secondary repairs or reconstructions of the deltoid ligament.…”

Section: Introductionmentioning

confidence: 99%

Strain pattern of each ligamentous band of the superficial deltoid ligament

Takao¹,

Ozeki

Oliva

et al. 2020

Preprint

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“…Metitiri et al (21) destacaram os altos graus de erro e imprecisão nas medições, o que poderia ser uma desvantagem e limitação para o teste de estresse manual na detecção de instabilidade. A artroscopia relatada para avaliação da lesão do DL pode ser considerada uma alternativa válida (19,22,23) .…”

Section: Discussionunclassified

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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Repair of Acute Superficial Deltoid Complex Avulsion During Ankle Fracture Fixation in National Football League Players

Abstract: Level IV, retrospective case series.

Cited by 67 publications

References 21 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

Strain pattern of each ligamentous band of the superficial deltoid ligament

Comparison of deltoid ligament repair and syndesmotic fixation in malleolar fractures

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