SLR - February 2022 - Jonathan S. Engelhardt
Reference: Nacime Salomão Barbachan Mansur, Fernando Cepollina Raduana, Andre Vitor Kerber Cavalcante Lemos, Daniel Soares Baumfeld, Gustavo Tadeu Sanchez, Marcelo Pires do Pradoc, Caio Augusto de Souza Nery. Deltoid Ligament Arthroscopic Repair in Ankle Fractures: Case Series. Injury. 2021 Jun 52;10Level of Evidence: Level IV
Scientific Literature Review
Reviewed By: Jonathan S. Engelhardt, DPM
Residency Program: St. Mary’s General Hospital – Passaic, NJ
Podiatric Relevance: In approximately 40 percent of ankle fractures, damage to the medial ligamentous complex is present, causing instability and possible deformity at the level of the ankle joint. The decision on whether to repair the medial ligament complex has mostly been left to surgeon preference as there has been a scarcity of evidence one way or another. This article attempts to shed light on the relatively low complication rates and high success rates of arthroscopic deltoid ligament repair with concomitant ankle fractures.
Methods: This study was retrospective in nature, including data between June 2016 through January 2020 and compared VAS and AOFAS scores before and after arthroscopic repair of the deltoid ligament in acute ankle fractures. Participants were male (55 percent) and female (45 percent) ranging from 18-70 years old. Patients were followed for a minimum of 6 months after stabilization and complications were measured (infection, nerve damage, re-rupture, dehiscence, non-union).
Results: Mean follow up was 6-48 months and out of 20 ankle fractures that were operated on, none were found to have any medial ankle instability nor were any noted to have any radiographic findings of deformity. AOFAS scores showed a mean of 93.5 (87-100 SD 7.25) and VAS value showed a mean of 0.75 (0–3.1 SD 1.05). In 2 cases, limited range of motion was noted compared to the contralateral ankle and one superficial infection was managed with antibiotics. None of the observed complications had any effect on stability of the medial complex.
Conclusions: The authors concluded that the final AOFAS scores presented in this study are comparable to ones in articles that study open repair of the medial ankle ligament complex. These results show that arthroscopic technique is a good predictor of functional outcome. As there were no major complications associated with this study, support for an arthroscopic approach as opposed to an open one might be viewed as superior from a safety perspective. Arthroscopic repair of the medial ankle ligamentous complex appears to be a safe procedure to perform on existing acute ankle fractures as noted above. If there is either clinical or radiographic evidence showing that some instability exists medially within the ankle joint complex, a medial ligament repair may help patients' functional outcome.