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. 2019;39(1):21-27.

Anatomic Syndesmotic and Deltoid Ligament Reconstruction with Flexible Implants: A Technique Description

Christina J Hajewski  1 , Kyle Duchman  1 , Jessica Goetz  1 , John Femino  1
Affiliations

Anatomic Syndesmotic and Deltoid Ligament Reconstruction with Flexible Implants: A Technique Description

Christina J Hajewski et al. Iowa Orthop J. 2019.

Abstract

The optimal fixation method for unstable syndesmosis (SYN) injuries remains a matter of debate between rigid screw fixation that stabilizes all three components of the syndesmosis but prohibits any motion, and flexible implants stabilizing by compression along the axis of the interosseous ligament. More recently additional repairs of the anterior or posterior SYN ligaments have been explored both clinically and biomechanically. The role for deltoid ligament (DL) repair or reconstruction in the setting of SYN injury remains controversial. However, the DL is increasingly recognized as having an important contribution to rotational stability of the ankle. A method of treatment is presented for unstable SYN injuries with flexible implants. An anatomic approach to reconstructing the DL with specific augmentation of the anterior and posterior bands of the deep deltoid ligament (DDL) is described for immediate restoration of medial ankle rotational stability. Level of Evidence: V.

Keywords: deltoid; syndesmosis.

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Conflict of interest statement

Disclosures: Dr. Femino is a paid consultant for Arthrex, Inc. and Integra LifeSciences.

Figures

Figure 1
Figure 1
Medial view of dissected ankle specimen with flexor retinaculum removed demonstrating the superficial deltoid ligament (SDL). MM = medial malleolus
Figure 2
Figure 2
Lateral view of intact syndesmosis. AITFL = anterior inferior tibiofibular ligament, IOL = interosseous ligament, T = tibia, F = fibula, Ta = talus
Figure 3
Figure 3
Medial ankle after sectioning of the deep deltoid ligament with superficial deltoid ligament (SDL) intact. T = tibia, Ta = talus
Figure 4
Figure 4
Placement of Kirschner wire in preparation for TightRope application. Arrows demonstrate reduction forces with compression and an internal rotation moment applied over the anterior fibula. T = tibia, F = fibula
Figure 5
Figure 5
Complete syndesmotic reconstruction with a suture button (SB) A and AITFL reconstruction with FiberTape. B T = tibia, F = fibula
Figure 6
Figure 6
Position of drill for the placement of 3.5 mm SwiveLock anchor in the talus near the footprint of the posterior insertion of the C deep deltoid for the posterior deep deltoid reconstruction. T = tibia, Ta = talus
Figure 7
Figure 7
(A) Anterior posterior (AP) view of the ankle after completion of the posterior deep deltoid reconstruction with Fiber Tape (B) Lateral view of the medial ankle after posterior deep deltoid reconstruction. Dashed line demonstrates the trajectory of the reconstruction which is obscured by the superficial deltoid ligament. T = tibia, Ta = talus
Figure 8
Figure 8
(A)Anterior posterior (AP) view of the medial ankle after the anterior deep deltoid reconstruction (B) Lateral view of the medial ankle after anterior deep deltoid reconstruction. Dashed line demonstrates the trajectory of the reconstruction which is obscured by the superficial deltoid ligament. T = tibia, Ta = talus
See this image and copyright information in PMC

References

    1. Egol KA, Pahk B, Walsh M, Tejwani NC, Davidovitch RI, Koval KJ. Outcome after unstable ankle fracture: effect of syndesmotic stabilization. Journal of orthopaedic trauma. 2010;24(1):7–11. Epub 2009/12/26. - PubMed
    1. Court-Brown CM, McBirnie J, Wilson G. Adult ankle fractures--an increasing problem? Acta orthopaedica Scandinavica. 1998;69(1):43–7. Epub 1998/04/03. - PubMed
    1. Weening B, Bhandari M. Predictors of functional outcome following transsyndesmotic screw fixation of ankle fractures. Journal of orthopaedic trauma. 2005;19(2):102–8. Epub 2005/01/29. - PubMed
    1. Kennedy JG, Soffe KE, Dalla Vedova P, Stephens MM, O’Brien T, Walsh MG, et al. Evaluation of the syndesmotic screw in low Weber C ankle fractures. Journal of orthopaedic trauma. 2000;14(5):359–66. Epub 2000/08/05. - PubMed
    1. Sagi HC, Shah AR, Sanders RW. The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up. Journal of orthopaedic trauma. 2012;26(7):439–43. Epub 2012/02/24. - PubMed

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