Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 9 , ISSUE S1 ( August, 2022 ) > List of Articles


Deltoid and Spring Ligament Reconstruction: The Quadrangular Construct

Pradeep Moonot, Prashant P Pawar, Hatesh Kumar

Keywords : Ankle joint, Deltoid ligament, Internal brace, Spring ligament

Citation Information :

DOI: 10.5005/jp-journals-10040-1234

License: CC BY-NC 4.0

Published Online: 29-07-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: The majority of the ankle injuries involves the lateral ankle ligaments, while deltoid ligament injuries are seen in 5%. Both deltoid and spring ligament are primary medial stabilizer of ankle and foot and can be injured simultaneously. Purpose: In this article, we explain a method for combined deltoid and spring ligament reconstruction using Internal Brace™ (Arthrex, Naples, USA) fibertape which mimics the anatomical ligament complex along with the lateral ligament reconstruction. Conclusion: It is a safe and simple technique with promising results at 1 year follow-up.

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  1. Baumhauer JF, Alosa DM, Renström PA, et al. A prospective study of ankle injury risk factors. Am J Sports Med 1995;23(5):564–570. DOI: 10.1177/036354659502300508
  2. Waterman BR, Belmont Jr PJ, Cameron KL, et al. Risk factors for syndesmotic and medial ankle sprain: role of sex, sport, and level of competition. Am J Sports Med 2011;39(5):992–998. DOI: 10.1177/0363546510391462
  3. Kerkhoffs GM, Rowe BH, Assendelft WJ, et al. Immobilisation and functional treatment for acute lateral ankle ligament injuries in adults. Cochrane Database Syst Rev 2002;(3):CD003762. DOI: 10.1002/14651858.CD003762
  4. Peters JW, Trevino SG, Renstrom PA. Chronic lateral ankle instability. Foot Ankle Int 1991;12(3):182–191. DOI: 10.1177/107110079101200310
  5. Takao M, Matsui K, Stone JW, et al. Arthroscopic anterior talofibular ligament repair for lateral instability of the ankle. Knee Surg Sports Traumatol Arthrosc 2016;24(4):1003–1006. DOI: 10.1007/s00167-015-3638-0
  6. Savage-Elliott I, Murawski CD, Smyth NA, et al. The deltoid ligament: an in-depth review of anatomy, function, and treatment strategies. Knee Surg Sports Traumatol Arthrosc 2013;21(6):1316–1327. DOI: 010.1007/s00167-012-2159-3
  7. Michelson J, Hamel A, Buczek F, et al. The effect of ankle injury on subtalar motion. Foot Ankle Int 2004;25(9):639–646. DOI: 10.1177/107110070402500908
  8. Cain JD, Dalmau-Pastor M. Anatomy of the deltoid–spring ligament complex. Foot Ankle Clin 2021;26(2):237–247. DOI: 10.1016/j.fcl.2021.03.001
  9. Hintermann B, Valderrabano V, Boss A, et al. Medial ankle instability: an exploratory, prospective study of fifty-two cases. Am J Sports Med 2004;32(1):183–190. DOI: 10.1177/0095399703258789
  10. Deland JT, de Asla RJ, Segal A. Reconstruction of the chronically failed deltoid ligament: a new technique. Foot Ankle Int 2004;25(11):795–799. DOI: 10.1177/107110070402501107
  11. Jeng CL, Bluman EM, Myerson MS. Minimally invasive deltoid ligament reconstruction for stage IV flatfoot deformity. Foot Ankle Int 2011;32(1):21–30. DOI: 10.3113/FAI.2011.0021
  12. Wiltberger BR, Mallory TM. A new method for the reconstruction of the deltoid ligament of the ankle. Orthop Rev 1972:1:37–41.
  13. Brodell Jr JD, MacDonald A, Perkins JA, et al. Deltoid-spring ligament reconstruction in adult acquired flatfoot deformity with medial peritalar instability. Foot Ankle Int 2019;40(7):753–761. DOI: 10.1177/1071100719839176
  14. Pellegrini MJ, Carcuro G. Chronic deltoid ligament insufficiency repair with Internal Brace™ augmentation. Foot Ankle Surg 2020;26(7):835. DOI: 10.1016/j.fas.2020.08.007
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