Deltoid ligament injuries: A review of the anatomy, diagnosis and treatments

Abstract

Purpose: Ankle sprains remain the most common soft tissue injury presenting to Emergency Departments. Recently, there has been increased awareness and reporting of deltoid ligament injuries in association with injuries to the lateral ligament complex as well as with fibula fractures. This article reviews the currently available literature on the anatomy of the deltoid ligament, clinical and radiological diagnosis of injuries to the deltoid ligament and treatment recommendations.

Methods: A literature review was conducted for keywords associated with deltoid ligament injuries. MEDLINE, PubMed and Embase databases were utilised for this search. Articles were included if involving an adult population, were English-language, were related to deltoid ligament injuries (with or without associated injuries) and reported on patho-anatomy, clinical or radiological diagnosis or treatment methods.

Results: A total of 93 articles were assessed for relevance from the database search, and 47 were included after the removal of irrelevant articles and duplicates. Several studies reported on the clinical findings of deltoid ligament injury, as well as the radiographic analysis. Arthroscopy was considered the gold standard of diagnosis, with authors reporting on the potential benefit of performing arthroscopic repair or reconstruction at the same time. There were no studies that provided a system for the classification of deltoid ligament injury or larger studies of treatment pathways. Long-term studies of the incidence of instability in deltoid ligament injuries were not available.

Conclusion: There is limited evidence available regarding deltoid ligament injuries, particularly in terms of treatment options, either in isolation or with concomitant injuries. Long-term follow-up studies are needed to obtain more accurate data on the number of complications.

Level of evidence: Level IV.

Keywords: ankle instability; deltoid ligament; medial ankle injury; soft tissue ankle.

Figure 1

Frontal cross‐section of a specimen showing the distribution of the deltoid ligament in two planes. 1. Superficial deltoid. 2. Deep deltoid.

Figure 2

Medial view of an osteoarticular dissection showing the tension of deltoid ligament fibres. (a) Ankle plantarflexion (anterior deltoid fibres are tense), (b) ankle dorsiflexion (posterior deltoid fibres are tense).