Orthopedic Surgery Department, Hamad General Hospital, PO Box 3050, Doha, Qatar.
Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar.
Int Orthop. 2020 Feb;44(2):341-347. doi: 10.1007/s00264-019-04416-9. Epub 2019 Nov 27.
The indications of deltoid ligament repair in ankle injuries with widened medial clear space in the absence of medial malleolus fracture remain controversial. Many authors reported no difference in long-term functional outcomes, while others stated that persistent medial clear space widening and malreduction are higher when deltoid ligaments went without repair. This meta-analysis aims to report the current published evidence about the outcomes of deltoid ligament repair in ankle fractures.
Several databases were searched through May 2018 for comparative studies. The primary outcome was the medial clear space correction, while secondary outcomes included maintenance of medial clear space reduction, pain scores, functional outcome, and total complications if any. Three comparative studies met the inclusion criteria for the meta-analysis. The analysis included a total of 192 patients, 81 in the deltoid ligament repair group and 111 in the non-repair group.
The medial clear space correction and maintenance of the said correction on final follow-up radiographs were superior in the deltoid ligament repair group. Although the pain scores were better in the repair group at the final follow-up, this did not result in a better functional outcome, with similar total complication rates.
In conclusion, those who had their deltoid ligament repaired had superior early and late radiological correction of the medial clear space, an indicator of the quality of ankle reduction with better pain scores. However, no differences in the functional outcome and complications rate were reported.
在没有内踝骨折的情况下，伴有内侧间隙增宽的踝关节损伤中，三角韧带修复的适应证仍存在争议。许多作者报告说，长期功能结果没有差异，而其他作者则指出，三角韧带未修复时，内侧间隙持续增宽和复位不良的发生率更高。本荟萃分析旨在报告目前关于踝关节骨折三角韧带修复结果的现有证据。
通过 2018 年 5 月对多个数据库进行了检索，以寻找比较研究。主要结果是内侧间隙校正，次要结果包括维持内侧间隙缩小、疼痛评分、功能结果和任何总并发症。有 3 项比较研究符合荟萃分析的纳入标准。该分析共纳入 192 例患者，三角韧带修复组 81 例，非修复组 111 例。
三角韧带修复组在最终随访 X 线片上的内侧间隙校正和维持方面表现更好。尽管修复组在最终随访时的疼痛评分更好，但这并没有导致更好的功能结果，总并发症发生率相似。
总之，那些接受三角韧带修复的患者在早期和晚期的内侧间隙放射学矫正方面具有优势，这是踝关节复位质量的一个指标，疼痛评分更好。然而，在功能结果和并发症发生率方面没有差异。
