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Deltoid Ligament Reconstruction: A Novel Technique with Biomechanical Analysis

Background: Deltoid ligament insufficiency has been shown to decrease tibiotalar contact area and increase peak pressures within the lateral ankle mortise. This detrimental effect may create an arthritic ankle joint if left unresolved. Reconstructive efforts thus far have been less than satisfactory...

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Bibliographic Details
Published in:Foot & ankle international 2010-07, Vol.31 (7), p.639-651
Main Authors: Haddad, Steven L., Dedhia, Sunil, Ren, Yupeng, Rotstein, Jason, Zhang, Li-Qun
Format: Article
Language:English
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Summary:Background: Deltoid ligament insufficiency has been shown to decrease tibiotalar contact area and increase peak pressures within the lateral ankle mortise. This detrimental effect may create an arthritic ankle joint if left unresolved. Reconstructive efforts thus far have been less than satisfactory. We describe a novel technique that reconstructs both main limbs of the deltoid ligament in anatomic orientation while providing secure graft fixation. Materials and Methods: Six pairs of fresh frozen cadaveric lower extremities were utilized. Matched right and left lower limbs (one pair) were allocated either to a deltoid reconstruction group or an intact deltoid group. The anterior tibial tendon was chosen as the graft for ligament reconstruction, and was harvested from the ipsilateral specimen. Tunnels were created in the distal tibia at the deltoid origin, and at the talus (deep) and calcaneus (superficial) deltoid insertions. Following measurement, the graft was cut to the appropriate size and endobuttons weaved into both tendon ends. The graft ends were passed through the talus and calcaneus respectively. The residual graft loop was then routed through the tibial tunnel and secured proximally with a cancellous screw post and spiked washer. Following specimen mounting, a multiaxis testing apparatus with three separate motors allowed three planes (dorsiflexion/plantarflexion; inversion/eversion; and internal/external rotation) of motion. Angular rotations and linear translations of the tibia in the X-Y-Z directions were measured for a given torque in external/internal rotation, dorsiflexion/plantarflexion, or eversion/inversion, under a constant velocity of 2 degrees per second. Testing consisted of a 2 Nm preload for 20 cycles in internal rotation/external rotation and inversion/eversion prior to data collection of 10 cycles at this level of torque. Similarly, a preload of 1 Nm for 20 cycles was used in dorsiflexion/plantarflexion prior to data collection of 10 cycles at this torque level. Data were collected in the control specimens (the matched contralateral extremity) with the deltoid ligament intact, and following complete sectioning of the ligament complex (both bundles). Results: Angular displacement at a 2 Nm level torque was significantly greater in the sectioned group compared to the deltoid reconstruction group in external rotation and eversion (p = 0.006 and p = 0.017 respectively). There was no statistical difference in angular displacement bet
ISSN:1071-1007
1944-7876
DOI:10.3113/FAI.2010.0639