Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Surgery

Supervisor

Del Balso, Christopher

2nd Supervisor

Lawendy, Abdel-Rahman

Co-Supervisor

Abstract

Transsyndesmotic ankle injuries lead to high rates of post-traumatic arthritis, despite appropriate methods of fixation. Current treatment involves syndesmotic screws or suture button fixation. Deltoid ligament repair has been considered an additional treatment option. The purpose of this study was to understand the role of the deltoid ligament in the context of syndesmotic instability, and the effect of deltoid ligament repair on ankle and syndesmotic biomechanics in a cadaveric model. Deltoid ligament repair in isolation was additionally compared to current fixation methods.

The deltoid ligament serves as an indirect stabilizer of the syndesmosis in flexion and rotation. Sectioning the deltoid ligament destabilizes the tibiotalar joint, leading to increased ankle motion and decreased stiffness. Deltoid ligament repair reduces rotational tibiotalar motion and is equivalent to screw fixation. Combined deltoid ligament repair and syndesmotic screw fixation is the most biomechanically stable construct. The clinical implications of deltoid ligament repair require further study.

Summary for Lay Audience

Transsyndesmotic ankle injuries are an injury pattern which often leads to posttraumatic, arthritis despite using appropriate repair methods such as syndesmotic screws or suture button fixation. An increased number of orthopaedic surgeons are considering repairing the deltoid ligament, a main stabilizer of the ankle joint. The purpose of this thesis was to understand the contribution of the deltoid ligament in these types of injuries and how its repair compares to traditional fixation options. A systematic review of the current literature, and a cadaveric biomechanical analysis were used to explore the role of the deltoid ligament and its repair in transsyndesmotic injuries. The deltoid ligament was found to be an indirect stabilizer of the syndesmosis in flexion and rotation of the ankle. Sectioning the deltoid ligament destabilizes the tibiotalar joint, leading to more ankle motion and decreased stiffness. Deltoid ligament repair provides similar biomechanical stability when compared to syndesmotic screw fixation. Combined deltoid ligament repair and syndesmotic screw fixation is the most biomechanically stable construct.

Download

Included in

Orthopedics Commons

Share

COinS