Deltoid Ligament Injuries Associated With Ankle Fractures

Arguments For and Against Direct Repair

Jesse F. Doty, MD; Burton D. Dunlap, MD; Vinod K. Panchbhavi, MD, FACS; Michael J. Gardner, MD


J Am Acad Orthop Surg. 2021;29(8):e388-e395. 

In This Article


The deltoid ligament plays an important role in maintaining concentric talus reduction within the ankle mortise. The clinical relevance of surgically addressing the radiographic findings of MCS widening and talus rotation in the setting of acute ankle fractures remains less defined. Although axially loading the ankle confers a component of stability, repair of the deltoid ligament can provide another checkrein to restore more native biomechanics. In low-demand patients, fracture fixation of the fibula may restore normal ankle biomechanics to a functional level with acceptable long-term outcomes. Table 2 briefly summarizes the pros and cons to repairing versus not repairing the deltoid ligament. A thorough review of current publications suggests less optimal outcomes may be seen in more active patients or subgroups of certain fracture patterns without direct ligament repair. When beneficial, acute surgical repair can be done quickly and with low complications.