SLR - April 2020 - Zachary G. Bennett

Suture Anchors for Primary Deltoid Ligament Repair Associated with Acute Ankle Fractures 

Reference: Shen J, Gao Y, Huang J, Qiu Q, Cheng L, Tong S. Suture Anchors for Primary Deltoid Ligament Repair Associated with Acute Ankle Fractures. Acta Orthop Belg. 2019 Sep;85(3):387-391 

Scientific Literature Review 

Reviewed By: Zachary G. Bennett  
Residency Program: Hennepin County Medical Center – Minneapolis, MN 

Podiatric Relevance: Primary repair of deltoid ligament ruptures in the setting of ankle fractures remains controversial. The goal of this study was to evaluate the clinical effect of primary suture anchor repair in the treatment of deltoid ligament rupture associated with ankle fractures. 

Methods: Thirty-four patients who had undergone primary deltoid ligament repair with suture anchors in the setting of acute ankle fracture were evaluated. Patients excluded were as follows: chronic deltoid ligament injury, isolated deltoid ligament injury, medial malleolus fracture, tibia pilon fracture, open fracture and pathological fracture. Types of ankle fractures included: SER IV, PER III, PER IV and PAB IV. After fixation of fibular fracture and/or syndesmotic injury, stress radiograph was performed intraoperatively and if medial clear space (MCS) was greater than 5 millimeters then the deltoid ligament was repaired. At 6, 12, 24 months and final follow up, AOFAS scores were evaluated. VAS scores and MCS measurements were noted at final follow up. MCS was compared against the contralateral uninjured ankle.   

Results: Mean follow up was 28 months. The mean AOFAS score was 89.7, 92.7, 93.3 and 92.6 at 6, 12 and 24 months and final follow up, respectively. The mean VAS score was 1.06 at final follow up. The mean MCS was 9.10 millimeters preoperatively and 3.71 millimeters postoperatively. Mean MCS of contralateral uninjured ankle was 3.65 millimeters.  

Conclusions: Studies have shown that even small deviations from anatomic alignment of the ankle joint result in greatly reduced joint contact areas. The deltoid ligament plays a key role in ankle joint alignment and stabilization. In the 1980s and 1990s the standard of practice in some communities was to perform ankle ORIF and leave the deltoid ligament to heal without direct operative intervention. Recently there has been more literature addressing fixation of the deltoid ligament in ankle fractures. This study shows that using suture anchor for the primary repair of deltoid ligament rupture during the treatment of multiple types of ankle fractures patients can achieve satisfactory results. However, without a control group, the power of the results is limited. Further study needs to be done with larger sample size and comparison groups to establish the benefit of suture anchor primary deltoid ligament repair in the setting of acute ankle fractures.   

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