Deltoid Ligament Arthroscopic Repair in Ankle Fractures: Case Series

Study Overview
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Brief Summary
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To demonstrate the functional results of patients with ankle fractures operated with arthroscopic deltoid repair.

Detailed Description
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Introduction: The diagnosis and treatment of ankle medial ligament lesions in malleolar fractures have always been surrounded by controversies. Even in the certainty of deltoid involvement and its consequent instability, the direct repair of this structure is not a consensus. In recent years, the arthroscopic technique to approach this ligament has been described with the objective of potentiating clinical results and minimizing possible complications. Objective: To demonstrate the functional results of patients with ankle fractures operated with arthroscopic deltoid repair. Methods: This is a retrospective study in patients diagnosed with ankle fractures associated with acute deltoid injuries and submitted to a malleolar fixation and deltoid arthroscopic repair between January 2018 and January 2020. All patients will fill an epidemiological questionnaire and will be evaluated for pain and function according to the Visual Analogue Scale (VAS) and the American Orthopaedic Foot and Ankle Society Score (AOFAS) at 12 months (6-24 months) average of follow-up. Discussion: The inclusion of the deltoid complex and the low invasiveness of this technique can improve the clinical outcomes of these patients. Additional studies, with a prospective and comparative methodology are required to sustain this proposal.

Official Title
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Deltoid Ligament Arthroscopic Repair in Ankle Fractures: Case Series

Conditions
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Ankle Injuries, Ankle Fractures, Deltoid Ligament; Sprain (Strain) (Ankle), Ligament Rupture

Intervention / Treatment
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* Procedure: Arthroscopic Deltoid Repair


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - acute (less than two weeks) ankle fracture containing a medial ligament injury suspicion will be included. Syndesmotic lesion with a deltoid association will also be addressed Exclusion Criteria: previous surgery autoimmune diseases neuropathy inflammatory diseases radiographic preoperative findings of ankle arthritis open medial wound coagulopathies any other condition that would contraindicate surgery

Ages Eligible for Study
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Minimum Age: 15 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Arthroscopic<br>Deltoid Arthroscopic Repair in Ankle Fractures | Procedure: Arthroscopic Deltoid Repair<br>* . A 4.5 mm arthroscopic set was used to clean the joint and assess medial and associated injuries. After deltoid injury confirmation through the method already mentioned, the medial gutter was prepared. The ideal positioning for the bone anchor in the medial malleolus followed Vega's recommendations and was located in the inferolateral quadrant created by the intersection of two lines: (1) tibia-talar joint line and (2) tangent line to the medial malleolus joint surface.(14). Sutures were passed respecting the safe zone illustrated by Acevedo at al, at the area between the posterior tibial tendon and the saphenous vein (16-25mm) (15). Sutures were passed but not tightened.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| American Orthopedic Foot and Ankle Society - Hindfoot Score (AOFAS) | Functional Score (0 to 100 | 100 best score possible | 0 worst score possible) | Time Frame: 6th post-operative month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Visual Analogue Scale (VAS) | Pain Score (0 to 10 | 10 worst score possible | 0 best score possible) | Time Frame: 6th post-operative month | 
| Number of Complications related to Treatment | Complications were established as dehiscence, neural damage, infection, and re-rupture. Dehiscence was set inability to heal the soft tissue coverage until the end of the 4th post-operative week. Peripherical nerve damage defined as hypoesthesia or paresthesia not solved until the end of the 6th month after the surgery. Infection termed as clinical signs infection or pus drainage at the wound that required the use of antibiotics. Re-rupture classified as an ankle sprain event during the follow-up. | 6th post-operative month |