Arthroscopically Assisted Deep Deltoid Ligament Reconstruction Utilizing Suture Tape Augmentation for Treatment of Medial Ankle Instability in Acute Ankle Fractures: A Novel Technique and Case Series

Ankle fractures are injuries caused by rotational forces, commonly resulting in deltoid ligament damage. Disruption of the deltoid ligament is associated with medial ankle instability, which might require repair. Historically, these repairs have been through an open approach, which is more difficult to visualize the deep deltoid ligament due to overlying structures. Utilizing arthroscopy alongside suture tape augmentation may enhance postoperative outcomes. A retrospective analysis of 12 deidentified patients from 2 hospital systems examined 12 patients with bimalleolar equivalent, trimalleolar equivalent, or Maisonneuve-type ankle fractures of the ankle with increased medial clear space widening. Variables such as age, weight, body mass index (BMI), sex, side, history of previous ankle surgery, preoperative ambulatory status, length of hospital stay, and disposition were documented. A technique guide was also developed using 2 expert surgeons’ experience and opinions for using suture tape augmentation with the Arthrex InternalBrace system. We present a novel technique for the reconstruction of the deep deltoid ligament complex using our experience from these cases. Included in this guide are details on indications, setup, technique, postoperative protocol, and radiographic assessment. Following surgery with the technique, all patients exhibited reduced medial clear space, regained ambulation without assistance, and returned to full weight bearing. Arthroscopically assisted deep deltoid ligament reconstruction utilizing suture tape augmentation appears to be a successful procedure for restoring ankle function and radiographic parameters when used in conjunction with accepted open reduction and internal fixation (ORIF) techniques for bimalleolar or trimalleolar ankle fracture equivalents. Level of Evidence: Expert Opinion Level V.