Abstract
Research Type:
Level 2 - Prospective comparative study, Meta-analysis of Level 2 studies or Level 1 studies with inconsistent results
Introduction/Purpose:
Ankle fractures are among the most common orthopedic injuries and are frequent associated to deltoid ligament. Despite the high prevalence of this injury, there is still no consensus on the need for repair of the deltoid ligament. However, it is increasingly believed that, due to its role in rotational instability, repair should be performed in all cases. The use of arthroscopy associated with the treatment of ankle fractures allows the identification of associated injuries allows removing debris and proteases that can accelerate the process of joint degeneration. Arthroscopic deltoid ligament repair has been demonstrating results like open repair, with less local morbidity. This study aims to functionally evaluate patients undergoing surgical deltoid ligament repair and compare the currently available methods.
Methods:
A prospective observational study was conducted to monitor outcomes. Inclusion criteria included all patients over 18 years of age undergoing surgical treatment for ankle fractures, provided they had no prior surgeries on the affected ankle. Exclusion criteria included patients with chronic joint diseases, previous surgeries on the affected ankle, those unwilling to participate in the study, or those without the cognitive capacity to consent. All patients with surgical ankle fractures were approached arthroscopically, and the pattern of their ligament injuries was documented. The OMAS scale was applied to all participants after a minimum follow-up of two years, with data collected via telephone survey.
Results:
A study of 121 patients included 53 women (43.8%) and 68 men (56.2%). Regarding deltoid ligament injuries, 77 patients had no injury (63.6%), while 44 patients (36.4%) presented with deltoid ligament injury. Among the patients with deltoid injury, 33 cases (75.0%) were repaired; of these, 10 underwent open repair and 23 underwent arthroscopic repair. Tourniquet time was longer in cases where the deltoid ligament was repaired (p = 0.0068; 95% CI −35.34,−6.52). Functional outcomes measured by the OMAS scale showed an average score of 88 in patients without deltoid injury, 80 in patients with deltoid injury not requiring repair, 75 in those who underwent open deltoid repair, and 78 in those who underwent arthroscopic repair, indicating similar functional results between the two repair methods.
Conclusion:
This study helps surgeons in the decision-making process when treating ankle fractures with deltoid ligament injuries. By identifying clear injury patterns, it allows a more specific and individualized approach to treatment. The results also confirm that arthroscopic repair of the deltoid ligament is a safe and reliable method, providing functional outcomes similar to open repair, with the advantage of less local morbidity. These findings encourage the use of arthroscopy as an effective option for managing these injuries.