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Arthroscopic deltoid repair for acute internal ankle instability
ESSKA Academy. Caetano J. Nov 8, 2019; 286361
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Arthroscopic deltoid repair for acute internal ankle instability

AFAS Free Papers

Topic: Arthroscopy

Caetano J., Duarte-Silva M., Dias R., Wircker P., Figueiredo J., Côrte-Real N.
Hospital de Cascais, Dr. José de Almeida, Orthopaedics, Carnaxide, Portugal

Introduction: There is no consensus on deltoid ligament rupture management in ankle fractures. The main problem arises in Weber C type or Maisonneuve fractures, where this lesion is more frequent. The purpose of this paper is to present our results with deltoid arthroscopic repair in acute lesions, contributing to improve the evidence about internal ankle instability repairs.
Material and methods: In this retrospective study, the authors report a series of 9 cases of ankle fractures with associated internal instability, in which the deltoid ligament was repaired with anchors trough arthroscopy. The mean follow-up period was 6 months (range 6 to 12 months). We measured AOFAS score and an imagological evaluation was made.
Results: In our 9 patients, (6 male, 3 female) the mean age was 44 years old (range 27 - 56). Eight patients had a Maisonneuve fracture (without internal malleolar fracture) and 1 patient had an equivalent bimaleolar fracture. In every patient, internal instability was diagnosed with ankle arthroscopy and deltoid repair with anchor was made. No complications were registered.
Post-operative results: At 6 months follow-up, all patients present normal gait with normal range of motion. The mean AOFAS score was 88,3 (85-100). Three patients had residual pain with no limitation on daily activities. All radiographic evaluations showed congruent mortise and no loss of anatomical reduction.
Discussion: The internal ankle instability is still a controversial topic on ankle trauma. Besides the acute repair not being a routine gesture, we know for a fact that chronic instability treatment is far more demanding. The interest on internal repair is raising with recent series showing promising results of treatment in acute phase. Ankle arthroscopy is an excellent tool, not only to diagnose complex ligamentar lesions that can escape initial clinic and radiographic evaluation, but also to treat them at same time without the morbidity associated to open techniques.
Conclusion: The authors recommend Ankle Arthroscopy in cases which complex ligamentar lesions are suspecetd based on initial clinic and radiographic findings. This case series shows good results with internal acute repair.
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