The impact of arthroscopic repair of the tibionavicular bundle of the deltoid ligament on ankle fractures

BACKGROUND: Notwithstanding well-established ligament repair with ankle arthroscopy and a thorough understanding of deltoid ligament anatomy, evidence supporting early arthroscopic repair of the deltoid ligament (EAR-DL) remains limited. The purpose of this study was to compare EAR-DL with conservative treatment following ankle fracture. METHODS: This retrospective study evaluated 45 patients with deltoid ligament tears among 1165 ankle fractures. Patients were grouped based on the EAR-DL decision or conservative treatment. The EAR-DL decision is based on evidence gathered from clinical, radiological, and surgical findings. Patients with imaging-confirmed deltoid ligament injury and ≥ 12 months of follow-up were included; those with major concomitant injuries were excluded. Clinical and radiological outcomes, including instability, functional scores, return to sport, and medial clear space (MCS), were compared. The concomitant injury count (CIC) was developed to measure injury complexity; yet this exploratory score has not yet been validated or assessed for reliability. Final outcomes were evaluated using analysis of covariance (ANCOVA), controlling for baseline values. MCS ≤ 4 mm was considered normal, and ankle stability was assessed using anteromedial drawer and valgus stress tests. RESULTS: C3 was the most common fracture pattern in 14 patients (31.1%), followed by B3 in 9 patients (20.0%). The most common CIC level was 3, observed in 28 patients (62.2%). No recurrent instability occurred following EAR-DL, compared with 4 (15.4%) cases in the conservative group (p = 0.126). The return to sports was observed at an average of 33.04 ± 3.18 weeks in the conservative group and at 29.32 ± 1.60 weeks in the EAR-DL group (p < 0.001). CONCLUSIONS: In this retrospective cohort study, no statistically significant difference was found between the groups in recurrent instability. EAR-DL was associated with a smaller MCS and exploratory, unadjusted clinical outcomes compared with conservative management. Prospective, adequately powered studies are required to determine whether EAR-DL provides clinically meaningful benefits. LEVEL OF EVIDENCE: Level III, retrospective cohort study.