Deltoid Ligament Injuries in Athletes: Techniques of Repair and Reconstruction

Operative Techniques in Sports Medicine (Impact Factor: 0.21). 03/2010; 18(1):11-17. DOI: 10.1053/j.otsm.2009.10.001

ABSTRACT Deltoid ligament injuries are a source of valgus and rotational ankle instability and often occur as a result of athletic injury. The anatomy of the medial ankle ligament complex is reviewed and pertinent radiological findings are emphasized. The clinical evaluation of athletes with medial ankle instability as well as methods of repair and reconstruction of the deltoid ligament complex in those patients requiring surgical care are described.

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    ABSTRACT: A thorough knowledge of the ankle anatomy is absolutely necessary for diagnosis and adequate treatment of ankle injury. The ankle is among the most prevalent joints injured in sports, the ankle sprain being the most common ankle lesion. The ankle joint is formed by the distal tibia and fi bula, and the superior talus. Two ligamentous complexes join the bones that form the ankle: the ligaments of the tibiofibular syndesmosis (anteroinferior tibiofibular, posteroinferior tibiofibular, and the interosseous tibiofibular ligament) and the lateral (anterior talofibular, calcaneofibular, and the posterior talofibular ligament) and medial (superficial and deep component) collateral ligaments. The anterior talofibular ligament is the main stabilizer on the lateral aspect of the ankle, limiting the anterior translation and internal rotation of the talus. Because most ankle sprains occur by inversion, this ligament is the most frequently injured, and it has been involved in the soft-tissue impingement syndrome and the microinstability and the major instability of the ankle.
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    ABSTRACT: OBJECTIVE. The objectives of our study were to determine the accuracy of new MRI criteria in detecting tears of the superficial deltoid ligament of the ankle, the accuracy of established criteria for detecting deep deltoid ligament tears, the most common location of super-ficial deltoid ligament tears, and the frequency of other injuries associated with deltoid tears. MATERIALS AND METHODS. A chart review yielded 89 cases over a 3-year interval in which ankle MRI was followed by open or arthroscopic surgery and the surgical report described findings in the deltoid ligament. One case was excluded because the MRI study was technically inadequate. MRI and surgical reports were then compared for the presence and location of deltoid ligament tears. RESULTS. MRI findings of focal detachment of the superficial deltoid origin or detachment of the fascial sleeve of the medial malleolus yielded a sensitivity for superficial deltoid ligament tears of 83.3% (45/54) and specificity of 93.9% (31/33). Eight of nine prospectively missed tears were visible on retrospective review. All superficial deltoid tears involved the origin of the ligament from the medial malleolus, and six involved mid or distal bundles of the superficial deltoid as well. MRI findings of discontinuity or nonvisualization of discrete fibers yielded a sensitivity for deep deltoid ligament tears of 96.3% (26/27) and specificity of 97.9% (46/47). CONCLUSION. MRI has a high accuracy for deltoid ligament tears in consecutive cases prospectively evaluated by musculoskeletal radiologists. The location of superficial deltoid ligament tears differed in our series from findings previously reported in the imaging literature.
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    ABSTRACT: PURPOSE: A literature review of the deltoid ligament was conducted, examining the current literature on anatomy, function, and treatment strategies. In particular, anatomical inconsistencies within the literature were evaluated, and detailed anatomical dissections are presented. METHODS: A literature search was conducted on PubMed using keywords relevant to the deltoid ligament in the ankle and medial ankle instability. Primary research articles, as well as appropriate summary articles, were selected for review. RESULTS: While it is well defined that the deltoid is contiguous and divided into one superficial and one deep portion, the creation of the individual fibres may be artificial. Furthermore, while improvements in imaging techniques and arthroscopy have not led to a consensus on the anatomy of the ligament, they may help improve recognition of deltoid injuries. Once identified, the majority of deltoid injuries can be treated via conservative treatment. However, reparative and reconstructive treatment strategies can also be used for complex acute injuries or chronic medial ankle instability. CONCLUSION: Given the continuing evolution of the anatomical understanding of the ligament, the current treatment protocol for deltoid injuries requires further standardization, with an emphasis on proper diagnosis.
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