Acute deltoid injury in ankle fractures: a biomechanical analysis of different repair constructs

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Background: The importance of the deltoid ligament in the congruency and coupling of the tibiotalar joint is well known. The current trend is to repair it in cases of acute injuries in the context of ankle fractures; however, there is limited information on how it should be reconstructed. The objective of this study was to compare different deltoid ligament repair types in an ankle fracture cadaveric model. Methods: Sixteen cadaveric foot-ankle-distal tibia specimens were used. All samples were prepared as a supination external rotation ankle fracture model. Axial load and cyclic axial rotations were applied on every specimen using a specifically designed frame. This test was performed without deltoid injury, with deltoid injury, and after repair. The reconstruction was performed in 4 different ways (anterior, posterior, middle, and combined). Medial clear space (MCS) was measured for each condition on simulated weightbearing (WB) and gravity stress (GS) radiographs. Reflective markers were used in tibia and talus, registering the kinematics through a motion analysis system to record the tibiotalar uncoupling. Results: After deltoid damage, in all cases the MCS increased significantly on GS radiographs, but there was no increase in the MCS on WB radiographs. After repair, in all cases, the MCS was normalized. Kinematically, after deltoid damage, the tibiotalar uncoupling increased significantly. All isolated repairs achieved a similar tibiotalar uncoupling value as its baseline condition. The combined repair resulted in a significant decrease in tibiotalar uncoupling. Conclusion: Our results show that deltoid repair recovers the tibiotalar coupling mechanism in an ankle fracture model. Isolated deltoid repairs recovered baseline MCS and tibiotalar uncoupling values. Combined repairs may lead to overconstraint, which could lead to postoperative stiffness. Clinical studies are needed to prove these results and show clinically improved outcomes. Clinical Relevance: This study helps in finding the optimum deltoid repair to use in an acute trauma setting.
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Resolución de subvención de investigación para el desarrollo y fabricación de dispositivos médicos implantables para el tratamiento de enfermedades, trastornos y lesiones del pie y el tobillo, concedida por la Empresa Paragon 28, Inc. con sede en Englewood, Colorado, EEUU, empresa líder en dispositivos médicos enfocada exclusivamente en el mercado ortopédico de pie y tobillo. Convocatoria 2021. *PROYECTO: "ACUTE MEDIAL ANKLE INSTABILITY – HOW TO RECONSTRUCT?. A BIOMECHANICAL ANALYSIS". Institución/Empresa que conceden la subvención: PARAGON Inc. (EEUU). Nº ref. 529776-v1A. Subvención: 10.250 dólares. Cantidad destinada a analizar si en un modelo cadavérico con daño experimental de los ligamentos del tobillo, sometido a cargas axiales y rotacionales, es posible restablecer la estabilidad articular del tobillo mediante la reparación de los ligamentos mediales. Centros de Ejecución: Clínica Alemana y Universidad de los Andes, LIBFE. Santiago de Chile. Periodo de Ejecución: 16 de junio de 2021 al 31 de mayo de 2022. Investigador principal: Lcdo. D. Emilio Wagner Hitscheld Investigadores: Lcdo. D. Pablo Wagner Hitschfeld Lcdo. D. Felipe Palma Traro Dr. D. Rodrigo Guzmán Venegas Dr. D. Francisco José Berral de la Rosa Total de investigadores: 5
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Wagner E, Wagner P, Escudero MI, Pacheco F, Salinas D, Godoy-Santos AL, Palma F, Guzmán-Venegas R, Berral-de la Rosa FJ. Acute deltoid injury in ankle fractures: a biomechanical analysis of different repair constructs. Foot & Ankle International (Foot Ankle Int.) Sep. 2023; 44(9):905-912. ISSN: 1071-1007 EISSN 1944-7876
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