-
Journal of Orthopaedic Surgery (Hong... 2023The deltoid ligament is the primary stabilizer of the medial side of the ankle joint. It is a complex structure with an origin at the medial malleolus from where it... (Review)
Review
The deltoid ligament is the primary stabilizer of the medial side of the ankle joint. It is a complex structure with an origin at the medial malleolus from where it spreads fan shaped distally with an insertion into the medial side of the talus, calcaneus and navicular bone. This chapter gives an overview of the anatomy, function, and pathology of the deltoid ligament.The deltoid ligament can become insufficient as a result of an ankle injury or prolonged strain. In the acute setting, deltoid insufficiency often coincides with multi ligament injury the ankle joint; syndesmosis injury, or ankle fractures. Management in the acute phase remains a subject of debate. Some orthopedic surgeons have a tendency towards repair, whereas most trauma surgeons often treat the deltoid nonoperatively. In the chronic setting the ligament complex is often elongated as a result of prolonged strain. It often coexists with a hindfoot valgus, as is the case in planovalgus feet. In such a case a realignment procedure should be combined with the deltoid repair.
Topics: Humans; Fracture Fixation, Internal; Ligaments; Ankle Fractures; Ankle Injuries; Ankle Joint; Ligaments, Articular
PubMed: 37449811
DOI: 10.1177/10225536231182345 -
The Journal of the American Academy of... Sep 2019Injuries to the acromioclavicular (AC) joint are common in the athletic patient population. Most AC joint injuries occur in young males, typically from a direct fall... (Review)
Review
Injuries to the acromioclavicular (AC) joint are common in the athletic patient population. Most AC joint injuries occur in young males, typically from a direct fall onto the superior aspect of the shoulder when the arm is adducted. Numerous publications describing joint anatomy and biomechanics, surgical techniques for reconstruction, and rehabilitation protocols are available to guide treatment strategies for injuries to the AC joint. Treatment is typically nonsurgical for type I and II injuries and surgical for type IV and VI injuries. Controversy surrounds the indications for nonsurgical versus surgical treatment of type III and V injuries. Multiple surgical techniques have been described, including coracoclavicular (CC) screw fixation, coracoacromial ligament transfer, and numerous methods of CC ligament reconstruction. Anatomic CC ligament reconstruction can be performed either open or arthroscopically, with and without graft augmentation. This article will discuss clinically relevant anatomy and biomechanical properties of the AC joint and will review decision-making principles and treatment options for common AC joint injuries. An updated summary of clinical outcomes after AC joint treatment will also be presented.
Topics: Acromioclavicular Joint; Athletic Injuries; Evidence-Based Medicine; Humans; Ligaments, Articular; Orthopedic Procedures; Postoperative Complications
PubMed: 31008872
DOI: 10.5435/JAAOS-D-17-00105 -
Knee Surgery, Sports Traumatology,... Mar 2021The posterior cruciate ligament (PCL) represents an intra-articular structure composed of two distinct bundles. Considering the anterior and posterior meniscofemoral... (Review)
Review
The posterior cruciate ligament (PCL) represents an intra-articular structure composed of two distinct bundles. Considering the anterior and posterior meniscofemoral ligaments, a total of four ligamentous fibre bundles of the posterior knee complex act synergistically to restrain posterior and rotatory tibial loads. Injury mechanisms associated with high-energy trauma and accompanying injury patterns may complicate the diagnostic evaluation and accuracy. Therefore, a thorough and systematic diagnostic workup is necessary to assess the severity of the PCL injury and to initiate an appropriate treatment approach. Since structural damage to the PCL occurs in more than one third of trauma patients experiencing acute knee injury with hemarthrosis, background knowledge for management of PCL injuries is important. In Part 1 of the evidence-based update on management of primary and recurrent PCL injuries, the anatomical, biomechanical, and diagnostic principles are presented. This paper aims to convey the anatomical and biomechanical knowledge needed for accurate diagnosis to facilitate subsequent decision-making in the treatment of PCL injuries.Level of evidence V.
Topics: Adult; Biomechanical Phenomena; Female; Hemarthrosis; Humans; Knee; Knee Injuries; Knee Joint; Ligaments, Articular; Magnetic Resonance Imaging; Male; Posterior Cruciate Ligament; Posterior Cruciate Ligament Reconstruction; Radiography; Recurrence; Rotation; Tibia; Young Adult
PubMed: 33201271
DOI: 10.1007/s00167-020-06357-y -
The Journal of the American Academy of... Jul 2019The last stage of a supination-external rotation ankle fracture involves either transverse fracture of the medial malleolus or rupture of the deltoid ligament. When the... (Review)
Review
The last stage of a supination-external rotation ankle fracture involves either transverse fracture of the medial malleolus or rupture of the deltoid ligament. When the deltoid ligament ruptures, a "bimalleolar equivalent" ankle fracture occurs, and the surgeon is presented with several diagnostic and therapeutic challenges. In the native ankle, the deltoid ligament provides restraint to eversion and external rotation of the talus on the tibia. In bimalleolar equivalent ankle fractures, there is often gross medial instability even after fibular reduction. Retraction of the deltoid with subsequent healing in a nonanatomic position theoretically may cause instability, persistent medial gutter pain, and loss of function with risk of early arthritis. In mild cases, deltoid injury may not be obvious, and potential diagnostic techniques include preoperative and intraoperative stress radiography, MRI, and ultrasonography. The most common injury pattern is avulsion from the medial malleolus, and most current repair techniques involve direct repair of the capsular and deltoid injuries involving suture anchors in the medial malleolus and imbrication of the superficial and deep deltoid fibers. To date, there is limited evidence of superior clinical outcomes with the addition of deltoid repair compared with open reduction and internal fixation of the fibula alone.
Topics: Ankle Fractures; Ankle Injuries; Biomechanical Phenomena; Diagnostic Imaging; Female; Fracture Fixation, Internal; Humans; Ligaments, Articular; Male; Open Fracture Reduction; Orthopedic Procedures; Rupture; Treatment Outcome
PubMed: 30475279
DOI: 10.5435/JAAOS-D-18-00198 -
The Journal of the American Academy of... Jul 2020Injuries to the tibio-fibular syndesmotic ligaments are different than ankle collateral ligament injuries and occur in isolation or combination with malleolar fractures.... (Review)
Review
Injuries to the tibio-fibular syndesmotic ligaments are different than ankle collateral ligament injuries and occur in isolation or combination with malleolar fractures. Syndesmotic ligament injury can lead to prolonged functional limitations and ultimately long-term ankle dysfunction if not identified and treated appropriately. The syndesmosis complex is a relatively simple construct of well-documented ligaments, but the dynamic kinematics and the effects of disruption have been a point of contention in diagnosis and treatment. Syndesmotic ligament injuries are sometimes referred to as "high ankle sprains" because the syndesmotic ligaments are more proximal than the collateral ligaments of the ankle joint. Rotational injuries to the ankle often result in malleolar fractures, which can be combined with ankle joint or syndesmotic ligament injuries. Most of the orthopaedic literature to this point has addressed syndesmosis ligament injuries in combination with fractures and not isolated syndesmotic ligament injuries. Thus, we propose a simplified general video guide to do the diagnostic examinations and arthroscopic-assisted reduction based on current evidence-based medicine.
Topics: Anesthesia; Ankle Fractures; Ankle Injuries; Ankle Joint; Arthroscopy; Biomechanical Phenomena; Bone Screws; Evidence-Based Medicine; Fracture Fixation; Fracture Fixation, Internal; Humans; Ligaments, Articular; Patient Care Planning; Physical Examination; Radiography; Suture Techniques; Sutures
PubMed: 32109919
DOI: 10.5435/JAAOS-D-19-00358 -
Foot & Ankle Specialist Dec 2022The medial ankle ligamentous complex, which includes the deltoid, talocalcaneal, and calcaneonavicular ligaments, functions to provide stability to the medial ankle.... (Review)
Review
The medial ankle ligamentous complex, which includes the deltoid, talocalcaneal, and calcaneonavicular ligaments, functions to provide stability to the medial ankle. Injuries to the deltoid ligament can lead to medial-sided ankle pain, subsequent instability, and posttraumatic osteoarthritis given the altered biomechanics of the ankle joint. After completing a thorough physical examination, imaging modalities such as stress radiographs and magnetic resonance imaging can be used to confirm the diagnosis. Acute injuries to the deltoid ligament should be managed conservatively with a short course of immobilization. For patients with continued pain and instability following a regimen of nonoperative management, surgical intervention can be considered. Primary repair using suture anchor fixation to the medial malleolus can be utilized if sufficient tissue remains. However, if reconstruction is necessitated, autograft or allograft can be utilized in several described techniques. Therapeutic.
Topics: Humans; Ankle Injuries; Ankle; Joint Instability; Ankle Joint; Ligaments, Articular; Ankle Fractures; Magnetic Resonance Imaging; Pain
PubMed: 36210762
DOI: 10.1177/1938640021992915 -
Seminars in Musculoskeletal Radiology Jun 2023Sprains are the most frequent injuries of the ankle, especially in sports. Up to 85% of cases affect the lateral ligament complex. Multi-ligament injuries with...
Sprains are the most frequent injuries of the ankle, especially in sports. Up to 85% of cases affect the lateral ligament complex. Multi-ligament injuries with associated lesions of the external complex, deltoid, syndesmosis, and sinus tarsi ligaments are also common. Most ankle sprains respond to conservative treatment. However, up to 20 to 30% of patients can develop chronic ankle pain and instability.New concepts have been recently developed, based on arthroscopic advances, such as microinstability and rotatory ankle instability. These entities could be precursors of mechanical ankle instability and at the origin of frequently associated ankle injuries, such as peroneus tendon lesions, impingement syndromes, or osteochondral lesions.Imaging methods, especially magnetic resonance (MR) imaging and MR arthrography, are key in precisely diagnosing ligament lesions and associated injuries, facilitating an adequate therapeutic approach.
Topics: Humans; Ankle; Ankle Joint; Collateral Ligaments; Magnetic Resonance Imaging; Sprains and Strains; Joint Instability; Ankle Injuries; Ligaments, Articular
PubMed: 37230124
DOI: 10.1055/s-0043-1767767 -
Hand Clinics Nov 2021Lunotriquetral (LT) ligament injuries are uncommon, however, should be considered in patients with ulnar-sided wrist pain. LT injuries are often associated with other... (Review)
Review
Lunotriquetral (LT) ligament injuries are uncommon, however, should be considered in patients with ulnar-sided wrist pain. LT injuries are often associated with other injuries but can occur in isolation. Understanding the anatomy and pathomechanics will aid in making the diagnosis. Similar to other injuries, a thorough history and focused physical examination is critical. Radiographs may show normal findings; however, advanced imaging can support the diagnosis. Arthroscopy remains the gold standard for diagnosis. Most patients do well with conservative management; however, injury acuity and severity will direct surgical management. Anatomy, pathophysiology, and treatment options are discussed.
Topics: Arthroscopy; Humans; Ligaments, Articular; Radiography; Wrist Injuries; Wrist Joint
PubMed: 34602133
DOI: 10.1016/j.hcl.2021.06.008 -
JBJS Reviews Jun 2020The femoral attachment of the anterolateral ligament (ALL) of the knee is still under debate, but the tibial attachment is consistently between Gerdy's tubercle and the... (Review)
Review
The femoral attachment of the anterolateral ligament (ALL) of the knee is still under debate, but the tibial attachment is consistently between Gerdy's tubercle and the fibular head. The structure is less identifiable and more variable in younger patients. The ALL likely plays a role in rotational stability, but its impact on anterior stability is less clear. Numerous ALL reconstruction techniques have been described. Biomechanical analysis of these techniques has not shown clear benefits, but this literature is limited by the heterogeneity of techniques, graft choices, and study methodology. Clinical studies of combined anterior cruciate ligament (ACL) and ALL reconstruction are few but promising in lowering the risk of an ACL reinjury. To our knowledge, there are no studies showing the clinical outcomes of combined ACL and ALL reconstruction in pediatric patients, who are at higher risk for ACL graft failure than adults.
Topics: Humans; Knee Injuries; Knee Joint; Ligaments, Articular; Tenodesis; Treatment Outcome
PubMed: 33006459
DOI: 10.2106/JBJS.RVW.19.00136 -
Seminars in Musculoskeletal Radiology Apr 2021The pathoanatomy of carpal instability is multifactorial and usually complex. A thorough medical history and clinical examination are essential, as well as profound... (Review)
Review
The pathoanatomy of carpal instability is multifactorial and usually complex. A thorough medical history and clinical examination are essential, as well as profound knowledge of the specific instability patterns. The stability of the wrist is ensured by the carpal joint surfaces, by intact intra-articular (particularly the scapholunate interosseous ligament) and intracapsular ligaments, and by crossing extensor and flexor tendons, the latter making the proximal carpal row an "intercalated segment." An important classification feature is the distinction between dissociative and nondissociative forms of carpal instability. Among others, scapholunate dissociation, lunotriquetral dissociation, midcarpal instability, and ulnar translocation are the most common entities. Early forms of instability are considered dynamic. In the natural course, static instability of the wrist and osteoarthritis will develop. This review focuses on the pathoanatomical fundamentals of the various forms of carpal instability.
Topics: Carpal Bones; Humans; Joint Instability; Ligaments, Articular; Tendons; Wrist Joint
PubMed: 34082446
DOI: 10.1055/s-0041-1728711