Orthopaedic Department, University of Sassari, Sassari, Viale San Pietro 43, Italy.
Orthopaedic Department, University of Sassari, Sassari, Viale San Pietro 43, Italy.
Foot (Edinb). 2021 Dec;49:101714. doi: 10.1016/j.foot.2020.101714. Epub 2020 Jul 6.
The repair of a deltoid ligament injury, following an ankle fracture with involvement of the syndesmosis, has no univocal consensus. Also the surgical strategies in case of a subsequent chronic instability are still under debate. In this work the result of a double bundle anatomic reconstruction of deltoid ligament with ipsilateral autologous gracilis muscle tendon is presented.
A 50 year old active male patient came to our attention with a catastrophic medial ankle instability, a severe pronation of the hindfoot and disabling ankle pain. He reported a Weber type B fracture of the left ankle with a lesion of the syndesmosis treated with anatomic plate and screws and a transyndesmotic screw 8 months before. The imaging showed a complete deltoid ligament lesion. Due to the impossibility of a direct repair of the ligament, we performed the reconstruction of the medial ligamentous complex with an autologous gracilis tendon graft. 10 months after the medial ligamentous complex reconstruction, the patient showed an excellent recovery of walking ability, disappearance of pain under load and resumed an active lifestyle.
The deltoid ligament has a key role in ankle joint stability and its integrity promotes the recovery after ankle fractures. However, its lesion is often left untreated in the acute setting. The result of a chronic untreated deltoid ligament injury could be extremely disabling and the ligament reconstruction, when an optimal native deltoid ligament repair is not achievable, is the choice to restore ankle function and stability.
In the delayed treatment of a deltoid ligament rupture the described double bundle anatomic reconstruction with autologous tendon graft can be an effective and suitable option.
踝关节骨折伴下胫腓联合损伤时，三角韧带损伤的修复尚无明确共识。对于随后出现的慢性不稳定，手术策略仍存在争议。本研究介绍了一种使用同侧自体股薄肌腱进行三角韧带双束解剖重建的结果。
一名 50 岁的活跃男性患者因严重的内踝不稳定、后足严重旋前和踝关节疼痛而就诊。他报告说，他曾患有左踝关节 Weber B 型骨折，合并下胫腓联合损伤，采用解剖钢板和螺钉以及下胫腓联合螺钉治疗，8 个月前。影像学显示三角韧带完全损伤。由于无法直接修复韧带，我们采用自体股薄肌腱移植物进行了内侧韧带复合体重建。在进行内侧韧带复合体重建后 10 个月，患者的步行能力恢复良好，负重时疼痛消失，恢复了积极的生活方式。
三角韧带在踝关节稳定性中起着关键作用，其完整性促进了踝关节骨折后的恢复。然而，在急性情况下，其损伤往往未得到治疗。慢性未治疗的三角韧带损伤可能会导致严重的功能障碍，当无法进行理想的三角韧带修复时，韧带重建是恢复踝关节功能和稳定性的选择。
在三角韧带撕裂的延迟治疗中，描述的使用自体肌腱移植物的双束解剖重建可以是一种有效且合适的选择。
