Diagnosis and Management of Deltoid Ligament Injuries in Chronic Ankle Instability: A Systematic Review.

Background: The treatment of chronic ankle sprains has largely focused on lateral ankle instability in the literature. There is a scarcity of data regarding the diagnosis and management of chronic medial ankle instability secondary to deltoid ligament injury.

Methods: A literature search was performed using the National Center for Biotechnology Information (NCBI) database for studies evaluating chronic ankle instability (CAI) involving deltoid ligament pathology. Studies were evaluated for workup including clinical presentation, imaging, treatment algorithm and operative techniques. Descriptive statistical analysis was conducted across the pooled data set.

Results: Nine studies representing 516 patients with CAI were included in our analysis. Plain radiographs assessed talar-tilt angle in 440 patients (85%) and anterior displacement in 296 patients (57%). A total of 465 patients underwent magnetic resonance imaging, with deltoid injuries identified in 289 (62%) of patients. Of these 289 patients, superficial deltoid involvement was specified in 61 patients and deep deltoid in 146 patients. Surgical treatment most commonly included arthroscopy in 255 patients with open deltoid ligament repair in 199 patients. Repair method included suture anchors in 173 patients (87%), bone tunnels in 23 patients (12%), and unspecified technique in 3 patients (1.5%). Thirteen patients (6.5%) had suture anchor repairs augmented with an internal brace. Three patients underwent deltoid reconstruction with plantaris tendon autograft.

Conclusion: Deltoid ligament injuries are common in patients with CAI. These data improve our understanding of chronic deltoid injuries and can help patients and surgeons better comprehend the pathoanatomy of chronic ankle instability.

Level of evidence: Level III, retrospective cohort study.