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Deltoid ligament

Ryan B Rigby, Ryan T Scott
Acute deltoid injuries may occur with ankle fractures. They are often left to heal without repair, possibly leading to chronic medial ankle instability. Stress radiographs identify the need for surgical repair of fractures or soft tissue damage. Gravity stress views have benefits over manually stressing the ankle. MRI can explore the extent of medial soft tissue injuries. Arthroscopy can evaluate and potentially treat deltoid injuries. Interposition of the deltoid may preclude adequate fracture reduction. Except with deltoid tear, fractures should be reduced and fixated, then the deltoid assessed...
April 2018: Clinics in Podiatric Medicine and Surgery
Claar van Leeuwen, Timo Haak, Marnix Kop, Nikki Weil, Frank Zijta, Jochem Hoogendoorn
OBJECTIVES: Goal of this study was to investigate whether a gravity stress radiograph is beneficial in determining instability in Supination-External rotation (SER)-type ankle fractures without a medial fracture. METHODS: 39 Patients with a SER-type ankle fracture without a medial or posterior fracture and medial clear space (MCS) < 6 mm at regular mortise view were included. A gravity stress radiograph and Magnetic Resonance imaging (MRI)-scan were made. The MCS measurements of the regular and gravity stress radiographs were compared with the MRI findings (set as reference standard) to determine the sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values as indication for a complete deltoid ligament rupture...
February 13, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Caio Nery, Lucas Fonseca, Fernando Raduan, Marcus Moreno, Daniel Baumfeld
BACKGROUND: Lateral ankle ligament injury is among the most common orthopedic injuries. The objective of this study is to present the preliminary prospective results of treatment using the "Inside-Out" variant of the fully arthroscopic Broström-Gould technique. METHODS: Twenty six patients were included: 20 male and 6 female, aged 19-60 years, mean 41 years. All patients had positive "anterior drawer" and "talar tilt" tests. When necessary, cartilage injuries were treated with microfracture and arthroscopic resection for anterior impingement; three patients had hindfoot varus, on whom Dwyer osteotomy was performed; one patient had peroneal tendinopathy and was treated with tendoscopic debridement and another one had partial injury of the deltoid ligament, which was treated by direct repair...
March 22, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Shigeki Kubota, Tetsuya Abe, Masao Koda, Hideki Kadone, Yukiyo Shimizu, Yuki Mataki, Hiroshi Noguchi, Kengo Fujii, Aiki Marushima, Toru Funayama, Hiroaki Kawamoto, Yasushi Hada, Yoshiyuki Sankai, Masashi Yamazaki
Postoperative C5 paralysis is a serious complication of cervical spine surgery, with no established method for effective rehabilitation. A 67-year-old man presented with postoperative bilateral C5 paralysis following cervicothoracic surgery for ossification of the posterior longitudinal ligament (OPLL). Starting 15 days after surgery, left elbow joint training was performed 2-3 times weekly, for a total of 10 sessions, using an upper limb single-joint hybrid assistive limb (upper limb HAL-SJ). Right elbow joint training was also performed 5 times weekly starting 38 days after surgery, for a total of 10 sessions, using the upper limb HAL-SJ...
February 2, 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Min A Yoon, Suk-Joo Hong, Sun Hong, Chang Ho Kang, Baek Hyun Kim, In Seong Kim
Objective: To investigate the association between the magnetic resonance imaging (MRI) findings of adhesive capsulitis and shoulder muscle fat percentages using a multi-echo Dixon method. Materials and Methods: Twenty-four patients with clinical diagnoses of adhesive capsulitis and either intact rotator cuffs or Ellman grade 1 partial tears as indicated by MRI scans were included. Two radiologists independently evaluated MRI scans of adhesive capsulitis as follows: presence or absence of axillary recess capsular and extracapsular hyperintensities; thickness of the coracohumeral ligament; thickness of abnormal rotator interval soft tissue; and thickness of glenoidal/humeral axillary recess capsules...
January 2018: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
Jafet Massri-Pugin, Bart Lubberts, Bryan G Vopat, Jonathon C Wolf, Christopher W DiGiovanni, Daniel Guss
BACKGROUND: The deltoid ligament (DL) is the principal ligamentous stabilizer of the medial ankle joint. Little is known, however, about the contribution of the DL toward stabilizing the syndesmosis. The aim of this study was to arthroscopically evaluate whether the DL contributes to syndesmotic stability in the coronal plane. METHODS: Eight above-knee cadaveric specimens were used in this study. A lateral hook test was performed by applying 100 N of lateral force to the fibula in the intact state and after sequential transection of the DL, anterior-inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), and posterior-inferior tibiofibular ligament (PITFL)...
January 1, 2018: Foot & Ankle International
Tomoyuki Nakasa, Mikiya Sawa, Yasunari Ikuta, Masahiro Yoshikawa, Yusuke Tsuyuguchi, Nobuo Adachi
BACKGROUND: Osteochondral lesions of the talus (OLT) are recognized as being commonly associated with trauma. However, the etiology of OLT remains unclear. In the case of a posteromedial lesion of OLT (medial OLT), the deep layer of the deltoid ligament is located close to the medial OLT, and this relationship between a medial lesion and deltoid ligament could be a risk factor for medial OLT. The purpose of this study is to investigate the unique anatomic feature of the deep deltoid attachment to the talus in patients with medial OLT compared with patients with non-medial OLT...
December 22, 2017: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
William R Walter, Anna Hirschmann, Erin F Alaia, Elisabeth R Garwood, Zehava S Rosenberg
OBJECTIVE: This study determined the frequency and MRI appearance of osseous and ligamentous injuries in midtarsal (Chopart) sprains and their association with ankle sprains after acute ankle injuries. Prospective diagnosis of and interobserver agreement regarding midtarsal injury among musculoskeletal radiologists were also assessed. SUBJECTS AND METHODS: Two cohorts with ankle MRI were identified via a digital PACS search: patients who had undergone MRI within 8 weeks after ankle injury and control subjects who had not sustained ankle trauma...
February 2018: AJR. American Journal of Roentgenology
Seung Hun Woo, Su-Young Bae, Hyung-Jin Chung
BACKGROUND: There is no consensus on the optimal treatment or preferred method of operation for the management of acute deltoid ligament injuries during an ankle fracture fixation. This study aimed to analyze the outcomes of repairing the deltoid ligament during the fixation of an ankle fracture compared to conservative management. METHODS: We retrospectively evaluated 78 consecutive cases of a ruptured deltoid ligament with an associated ankle fracture between 2001 and 2016...
January 2018: Foot & Ankle International
Bart Lubberts, Daniel Guss, Bryan G Vopat, Jonathon C Wolf, Daniel K Moon, Christopher W DiGiovanni
BACKGROUND: To assist with visualization, orthopaedic surgeons often apply ankle distraction during arthroscopic procedures. The study aimed to investigate whether ankle distraction suppresses fibular motion in cadaveric specimens with an unstable syndesmotic injury. METHODS: Fourteen fresh-frozen above knee specimens underwent arthroscopic assessment with 1) intact ligaments, 2) after sectioning of the anterior inferior tibiofibular ligament, the interosseous ligament, and the posterior inferior tibiofibular ligament, and 3) after sectioning of the deep and superficial deltoid ligament...
December 2017: Clinical Biomechanics
Jordi Vega, Jörg Allmendinger, Francesc Malagelada, Matteo Guelfi, Miki Dalmau-Pastor
PURPOSE: When the anterior fascicle of the deltoid ligament is injured in patients with chronic ankle instability, the diagnosis of rotational ankle instability is supported. The aim of this study was to report the results of an all-arthroscopic technique to concomitantly repair the lateral collateral and deltoid ligaments to treat patients with rotational ankle instability. METHODS: Thirteen patients [12 men and 1 woman, median age 32 (15-54) years] with rotational ankle instability were treated by arthroscopic means after failing non-operative management...
October 5, 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Jafet Massri-Pugin, Bart Lubberts, Bryan G Vopat, Daniel Guss, Ali Hosseini, Christopher W DiGiovanni
BACKGROUND: Arthroscopic evaluation of the syndesmosis allows direct visualization of syndesmotic instability. The purpose of this study was to determine the minimum degree of ligamentous injury necessary to destabilize the syndesmosis in the coronal plane when assessed arthroscopically and pinpoint where such instability should be measured within the incisura. METHODS: Fourteen cadaveric specimens were divided into 2 groups and arthroscopically assessed first with the syndesmosis intact and then following serial differential ligamentous transection...
December 2017: Foot & Ankle International
Kenneth Nwosu, Brian Andrew Schneiderman, Stephen Joseph Shymon, Thomas Harris
BACKGROUND: Ankle joint stability dictates treatment in ligamentous supination external rotation ankle injuries (LSERAI). Investigation of the medial structures that support the ankle mortise is critical, and a small avulsion fracture, or "fleck", of the medial malleolus is occasionally encountered. This study aimed to assess the utility of this medial malleolus fleck sign (MMFS) in diagnosing instability requiring surgery in LSERAI. METHODS: This retrospective observational study examined 166 LSERAI at a single level I trauma center...
September 1, 2017: Foot & Ankle Specialist
Jeon Gyo Kim, Heui Chul Gwak, Myoung Jin Lee, Jung Woo Yoo, Ji Yong Park, Keon Hee Yun, Young Koo Lee
Deltoid ligament repair can be challenging, and implementation of an arthroscopic method can be useful in terms of minimizing morbidity associated with open dissection, as long as the repair is effective and durable. In this brief report, we describe a method of arthroscopic deltoid ligament repair that we have found to be useful.
November 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Ezekiel Oburu, Mark S Myerson
Deltoid ligament reconstruction allows for joint preservation of the ankle in the setting of patients a triple arthrodesis due to a flat foot deformity. Although the increased forces that may occur in the ankle joint after a triple arthrodesis cannot be eliminated, reconstruction of the ligament will delay and may prevent the onset arthritis, allowing the patient to maintain mobility of the ankle joint. The anatomy, surgery, and risks and benefits are discussed.
September 2017: Foot and Ankle Clinics
Sun Hwa Lee, Seong Jong Yun
OBJECTIVE: To evaluate the feasibility of point-of-care ankle ultrasound compared with magnetic resonance imaging (MRI) for diagnosing major ligaments and Achilles tendon injuries in patients with recurrent ankle sprain and chronic instability, and to evaluate inter-observer reliability between an emergency physician and a musculoskeletal radiology fellow. MATERIAL AND METHODS: A prospective cross-sectional study was conducted in an emergency department. Patients with recurrent ankle sprain and chronic instability were recruited...
October 2017: Injury
N Gougoulias, A Sakellariou
Stable fractures of the ankle can be safely treated non-operatively. It is also gradually being recognised that the integrity of the 'medial column' is essential for the stability of the fracture. It is generally thought that bi- and tri-malleolar fractures are unstable, as are pronation external rotation injuries resulting in an isolated high fibular fracture (Weber type-C), where the deltoid ligament is damaged or the medial malleolus fractured. However, how best to identify unstable, isolated, trans-syndesmotic Weber type-B supination external rotation (SER) fractures of the lateral malleolus remains controversial...
July 2017: Bone & Joint Journal
Junji Miller Fukuyama, Robinson Esteves Santos Pires, Pedro José Labronici, José Octávio Soares Hungria, Rodrigo Lopes Decusati
OBJECTIVE: To evaluate the frequency of deltoid ligament injury in bimalleolar supination-external rotation type fractures and whether there is a correlation between the size of the fractured medial malleolus and deltoid ligament injury . METHODS: Twenty six consecutive patients underwent magnetic resonance exams after clinical and radiographic diagnosis of bimalleolar supination-external rotation type ankle fractures . RESULTS: Thirteen patients (50%) presented deltoid ligament injury associated to bimalleolar ankle fracture...
January 2017: Acta Ortopedica Brasileira
Nicole M Stevens, Amy S Wasterlain, Sanjit R Konda
Irreducible ankle fractures are a relatively rare phenomenon. We present a case of a pronation abduction-type ankle fracture that was irreducible in the emergency room despite sedation. The patient was taken to the operating room, where the posterior tibialis tendon and retinaculum, deltoid ligament, and anteromedial capsule were found to be trapped within the joint. After removal of the tissue, alignment was restored. The patient did well clinically and was advanced to full weightbearing at 6 weeks. This is, to the best of our knowledge, the first report of entrapment of all 4 anatomic structures, preventing closed reduction...
July 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Joo-Yul Bae, Hee-Jae Won, Dong-Kyo Seo
We report a case of valgus ankle degenerative arthritis due to chronic isolated deltoid insufficiency combined with tibial varus that was treated successfully with ankle joint preserving surgery. A 63-year-old male complained of right lateral ankle pain with 10 minutes of maximal pain-free walking time. The assessed American Orthopaedic Foot and Ankle ankle-hindfoot scale score was 33 points. The ankle joint showed 18° of valgus deformity with 6° of tibia varus. Medial displacement calcaneal osteotomy, supramalleolar open wedge osteotomy, and deltoid ligament imbrication were performed...
July 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
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