Deltoid Ligament Injuries in Athletes: Techniques of Repair and Reconstruction
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: 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.American Journal of Roentgenology 01/2015; 204(1):W63-9. DOI:10.2214/AJR.13.11702 · 2.74 Impact Factor
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ABSTRACT: This book creates a unique platform that covers main ankle pathologies specifically related with football. Experiences from professional players have been combined with evidence-based medical content from renowned experts in the field to present a comprehensive picture on ankle injuries in football. Worldwide, ankle injuries present a high burden for sports medicine physicians, physiotherapists, players, and coaches in and around the football pitch. This book contains updated content for both medical and nonmedical individuals involved with football.The Ankle In Football, Edited by Pieter P.R.N d'Hooghe, Gino Kerkhoffs, 01/2014: chapter 20: pages 235-251; Springer., ISBN: 978-2-8178-0522-1
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ABSTRACT: Controversy exists concerning the need for operative repair of the deltoid ligament during management of acute ankle fractures. The purpose of our report was to identify the indications for surgical intervention for deltoid ligament injury in the setting of ankle fractures. Furthermore, we aimed to elucidate the clinical outcomes after deltoid ligament repair in this setting. This was a multicenter study, involving 4 clinical institutions. From January 2006 to December 2011, 1533 ankle fractures underwent surgical intervention. Of this group, 131 deltoid ligament ruptures (8.55%) were identified and repaired operatively. Of the 131 patients, 74 were male (56.5%) and 57 were female (43.5%), with a mean age of 33.2 (range 16 to 63) years. The outcome measures included the clinical examination findings, radiographic findings, American Orthopaedic Foot and Ankle Society ankle-hindfoot scores, visual analog scale (VAS) scores, and Medical Outcomes Study Short Form 36-item questionnaire scores. All incisions healed primarily. A total of 106 patients were followed up for a minimum of 12 (range 12 to 72) months, with an average follow-up period of 27 months. The mean interval to fracture union was 14.5 (range 9 to 16) weeks. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score at the latest follow-up visit was 91.4 (range 83 to 100) points. The mean visual analog scale score was 1.2 (range 0 to 6) points. The mean Short Form-36 score was 91.2 (range 80 to 96) points. Compared with the preoperative scores, all the 3 outcome measures had improved significantly postoperatively (p < .05). The postoperative stress radiographs did not reveal any ankle instability. None had evidence of post-traumatic arthritis of the ankle from the clinical examination and radiographs. A reasonable clinical evaluation and surgical repair was executed, with an appropriate repair technique chosen according to the site of deltoid ligament rupture. The results of the present multicenter study have shown that deltoid ligament rupture can be repaired in patients with an unstable medial ankle after fracture fixation and prevent ankle stabilization-related complications.The Journal of Foot and Ankle Surgery 01/2015; 54(2). DOI:10.1053/j.jfas.2014.12.013 · 0.98 Impact Factor