Direct Suture Repair of Deltoid Ligament Using Barbed Suture: A Cost-Effective Surgical Technique for Ligamentous Repair in Ankle Fractures

Background/Objectives: Deltoid ligament injury has been reported in up to 40% of ankle fractures, as confirmed by arthroscopy. Despite the frequency of this injury, there are multiple methods of fixation, including use of sutures, anchors and grafts, with no consensus in the field on a gold standard of operative technique for deltoid ligament injuries identified in bimalleolar equivalent ankle fractures. This manuscript aims to describe a novel surgical technique for deltoid ligament repair in the setting of bimalleolar equivalent ankle fractures. Surgical Technique: In this technique, following fixation of the fibula in bimalleolar equivalent ankle fractures, barbed polydioxanone (PDS) suture is utilized for direct repair of the deltoid ligament. This technique can be completed with the patient either prone or supine, uses standard fluoroscopy for evaluation of the competency of the deltoid ligament, and utilizes a familiar anteromedial approach to the medial malleolus. When compared to using anchors for repair of the deltoid ligament, barbed PDS suture seems to provide an equivalent and cost-effective strategy for repair. Conclusions: Repair of the deltoid ligament using suture anchors is a widely accepted method that has been demonstrated to provide successful repair. However, these anchors can be costly and rely on appropriate fixation in the bone to provide long-term fixation. This suture technique seems to offer a reliable, cost-effective technique for deltoid ligament repair.