Suture anchors for the repair of deltoid ligament injury: restore the stability of ankle joint. doi: /j.issn

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1 Chinese Journal of Tissue Engineering Research May 28, 2015 Vol.19, No.22 ( ) (13QNP014) :R318 :A : (2015) %. [J] (22): doi: /j.issn Suture anchors for the repair of deltoid ligament injury: restore the stability of ankle joint Tian Yong, Ma Xiao (Department of Orthopedics, the 253 Hospital of Chinese PLA, Hohhot , Inner Mongolia Autonomous Region, China) Abstract BACKGROUND: Ankle fractures combined with deltoid ligament injury are not uncommon in clinical practice, prone to misdiagnosis and missed diagnosis, resulting in ankle instability, chronic pain and traumatic arthritis. In recent years, because of the research and development of anatomy and biomechanical characteristics of deltoid ligament, the treatment and surgical methods of ankle fracture combined with deltoid ligament injury have progress and development, but it remains controversial. OBJECTIVE: To evaluate the clinical effect of suture anchor repair in the treatment of ankle fracture combined with deltoid ligament injury. METHODS: Twenty-seven patients with ankle fracture combined with deltoid ligament injury were selected between January 2010 and January The lateral malleolus and posterior malleolus fracture patients were treated with open reduction and internal fixation, and all the deltoid ligament injury patients were treated with anchor repair. The tibiofibular syndesmosis isolated patients received internal fixation with a cancellous bone screw. RESULTS AND CONCLUSION: All 27 patients were followed-up for months, averagely 23 months. The evaluation according to the American Orthopaedic Foot and Ankle Society score system showed that the excellent and good rate was 74.1%. The results indicate that anchor could perfectly restore the stability of ankle joint. Tian Yong, Master, Associate chief physician, Department of Orthopedics, the 253 Hospital of Chinese PLA, Hohhot , Inner Mongolia Autonomous Region, China Corresponding author: Tian Yong, Department of Orthopedics, the 253 Hospital of Chinese PLA, Hohhot , Inner Mongolia Autonomous Region, China Accepted: ISSN CN /R CODEN: ZLKHAH 3565

2 . Subject headings: Tissue Engineering; Ankle Joint; Fractures, Bone Funding: the Military Medical Science and Technology Youth Training Project in 2013, No. 13QNP014 Tian Y, Ma X. Suture anchors for the repair of deltoid ligament injury: restore the stability of ankle joint. Zhongguo Zuzhi Gongcheng Yanjiu. 2015;19(22): Introduction 50% [1] [2] 10% 15% [3] 26% [4-6] [7-9] [10-11] [12] [13] Fastin RC 5 mm [14] 1 Subjects and methods Lauge-Hansen [15] X % d 4 d 10 (Non-absorbable Suture Anchor System) YZB/USA Fastin RC 5mm (6 4) (Ethibond ) ( ) ( ) Fastin RC 5 mm 3566 P.O. Box 10002, Shenyang

3 C [ ] 2 U (American orthopedic foot and ankle society AOFAS) [20] AOFAS x _ ±s t 2 SPSS 17.0 P Results (P < 0.05) (P > 0.05) min 75 min 7 16 d 11.5 d X AOFAS ( 20 ) 5 2 ( 7 ) 74.1% h Lauge-Hansen mm 6 4 Ethibond 3 Discussion Lauge-Hansen X 2 mm 4 mm [21] X [22] MRI [22-23] C X > 4 mm [24] [25] ISSN CN /R CODEN: ZLKHAH 3567

4 Figure 1 Flowchart of intervention A B 2 ( 31 ) X Figure 2 Images of a 31-year-old male patient with ankle fracture and deltoid ligament injury before and after suture anchor repair A X 9 mm B X ( mm 1 Table 1 Clinical data of patients AOFAS (n=20) AOFAS (n=7) (x _ ±s ) 36.2± ±21.9 a 40 (n) 13 1 > 40 (n) 7 6 [n(%)] 12(60) 4(57.1) 8(40) 3(42.9) [n(%)] 10(50) 3(42.9) a 6(30) 1(14.3) a 4(20) 3(42.8) a 3.0± ±1.5 a (x _ ±s d) 4 d(n) 14 2 > 4 d(n) 6 5 [n(%)] 12(60) 4(57.1) 8(40) 3(42.9) a P < 0.05 AOFAS 15% 20% [26] 1 mm 20% 40%5 mm 80% [26] [27] [28] [29] [30-50] P.O. Box 10002, Shenyang

5 . 4 Ethibond 50 1/3 [51] 27 4 References [1],. [J].,2012, 18(19): [2] Stufkens SA, Knupp M, Lampert C, et al. Long-term outcome after supination-external rotation type-4 fractures of the ankle. J Bone Joint Surg Br. 2009;91(12): [3] Savage-Elliott I. The deltoid ligament: an in-depth review of anatomy,function,and treatment strategies. Knee Surg Sports Traumatol Arthrosc. 2013;21(6): [4] Hintermann B, Regazzoni P, Lampert C, at al. Arthroscopic findings in acute fractures of the ankle. J Bone Joint Surg Br. 2000;82(3): [5] Herscovici D Jr, Scaduto JM. Management of high-energy foot and ankle injuries in the geriatric population. Geriatr Orthop Surg Rehabil. 2012;3(1): [6] Fong DT, Chan YY, Mok KM, et al. Understanding acute ankle ligamentous sprain injury in sports. Sports Med Arthrosc Rehabil Ther Technol. 2009;1:14. [7] Van Schie-Van der Weert EM, Van Lieshout EM, De Vries MR, et al. Determinants of outcome in operatively and nonoperatively treated Weber-B ankle fractures. Arch Orthop Trauma Surg. 2012;132(2): [8] Stufkens SA, van den Bekerom MP, Knupp M, et al. The diagnosis and treatment of deltoid ligament lesions in supination-external rotaton ankle fractures: a review. Strategies Trauma Limb Reconstr. 2012;7(2): [9] Golanó P, Vega J, de Leeuw PA, Malagelada F, et al. Anatomy of the ankle ligaments: a pictorial essay. Knee Surg Sports Traumatol Arthrosc. 2010;18(5): [10],. 16 [J].,2014,(16) [11]. [J]., 2011,22(5): [12]. [J].,2008, 29(4): [13],,,. [J].,2006,14(20): [14] Lack W, Phisitkul P, Femino JE. Anatomic deltoid ligament repair with anchor-to-post suture reinforcement: technique tip. Iowa Orthop J. 2012;32: [15] Lauge-hansen N. Fractures of the ankle. III. Genetic roentgenologic diagnosis of fractures of the ankle. Am J Roentgenol Radium Ther Nucl Med. 1954;71: [16],,,. [J].,2013,19(9): [17],,,. [J].,2014,26(4): [18] Jeng CL, Bluman EM, Myerson MS. Minimally invasive deltoid ligament reconstruction for stage IV flatfoot deformity. Foot Ankle Int. 2011;32(1): [19],,. Tillaux-Chaput Volkmann [J].,2013, 33(4): [20].AOFAS[J].( ), 2014,4:37. [21] Gill JB, Risko T, Raducan V, et al. Comparison of manual and gravity stress radiographs for the evaluation of supination-external rotation fibular fractures. J Bone Joint Surg Am. 2007;89(5): [22] Henari S, Banks LN, Radovanovic I, at al. Ultrasonography as a diagnostic tool in assessing deltoid ligament injury in supination external rotation fractures of the ankle. Orthopedics. 2011; 34(10): [23] Chhabra A1, Subhawong TK, Carrino JA. MR imaging of deltoid ligament pathologic findings and associated impingement syndromes. Radiographics. 2010;30(3): ISSN CN /R CODEN: ZLKHAH 3569

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