SLR - April 2020 - Stephanie K. Ragan
Reference: Hardy, Connors, Zulauf, Coyer. Acute Deltoid Ligament Repair in Ankle Fractures Five-year Follow-up. Clinics in Podiatric Medicine and Surgery. 2019.Scientific Literature Review
Reviewed By: Stephanie K. Ragan, DPM
Residency Program: Hennepin County Medical Center – Minneapolis, MN
Podiatric Relevance: Partial or total rupture of deltoid ligaments are seen in 40-58 percent of ankle fracture patients. It is currently debated whether podiatric surgeons should repair the deltoid ligament in ankle fractures. A prospective randomized study reported no difference between repaired deltoid vs unrepaired deltoid in ankle fractures. However, another study reported that unrepaired deltoid ligament may be the source of persistent pain or pronation deformity. This study retrospectively analyzed patients undergoing acute medial deltoid ligament repair to determine patient satisfaction and return to normal activity levels post operatively.
Methods: A total of 14 Weber B or C ankle fractures (10 Weber B, 4 Weber C) with deltoid ligament rupture were identified and followed for an average of 70.6 months. Patients underwent deltoid ligament repair using suture tape and bioabsorbable anchors and fracture fixation with standard screw/plating techniques. Patients were contacted via phone and completed a modified patient outcome satisfaction survey that measured functional return to activity and pain relief postoperatively. At last clinical follow up, all patients were discharged with no restrictions.
Results: The mean preoperative pain scale was 9 out of 10, which improved to one out of 10 postoperatively. The median score rating the overall success of the procedure was 91.1 out of 100. The median satisfaction score for return to normal activity was 93 out of 100 and for higher demand activities was 88 out of 100. One patient underwent lateral hardware removal. Two patients complained of medial swelling with activity but reported no activity limitations. No infections or wound complications were reported.
Conclusions: The authors reported long-term patient satisfaction outcomes with repair of the deltoid ligament using suture anchors in an acute ankle fracture setting. Patients were able to return to normal functional activity and appeared to be satisfied with their outcomes with a decrease in pain scores and an increase in activity level. Limitations of this study include its small sample size with only some patients participating in the post op phone call which could create bias, lack of preoperative functional scores, and no control group. It was also unclear how long the patients were followed in clinic prior to being discharged. Overall this study supports fixing the deltoid ligament in terms of patient reported outcomes and supports the need for further research on this topic.