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Foot Ankle Surg. 2018 Nov 5. pii: S1268-7731(18)30120-6. doi: 10.1016/j.fas.2018.10.004. [Epub ahead of print]

Chronic deltoid ligament insufficiency repair with Internal Brace™ augmentation.

Author information

1
Department of Orthopaedic Surgery, Hospital Clinico Universidad de Chile, Clinica Universidad de Los Andes, Santos Dumont 999, Independencia, Santiago, 7640275, Chile. Electronic address: mpellegrini@hcuch.cl.
2
Department of Orthopaedic Surgery, Hospital Clinico Universidad de Chile, Clinica Universidad de Los Andes, Santos Dumont 999, Independencia, Santiago, 7640275, Chile. Electronic address: ntorreslara@gmail.com.
3
Department of Orthopaedic Surgery, Hospital Clinico Universidad de Chile, Clinica Universidad de Los Andes, Santos Dumont 999, Independencia, Santiago, 7640275, Chile. Electronic address: ncuchacovich@clinicalascondes.cl.
4
Medical Education Department, Senior Clinical Specialist Foot and Ankle, Naples, FL, USA. Electronic address: perfay.huertas@arthrex.com.
5
Department of Orthopaedic Surgery, Clinica Las Condes, Lo Fontecilla 441, Las Condes, Santiago, 7591046, Chile. Electronic address: gmunoz@clinicalascondes.cl.
6
Department of Orthopaedic Surgery, Hospital Clinico Universidad de Chile, Clinica Universidad de Los Andes, Santos Dumont 999, Independencia, Santiago, 7640275, Chile. Electronic address: gcarcuro@clinicauandes.cl.

Abstract

BACKGROUND:

Patients with chronic deltoid ligament insufficiency (CDLI) present a challenging situation. Although numerous procedures have been described, optimal treatment is still a matter of debate. While the treatment armamentarium ranges from simple ligament repair to complex reconstructions with or without realignment osteotomies, direct repair augmented with an Internal Brace™ device appears to be an attractive intermediate option. We investigated functional outcomes and complications in patients with CDLI operated on using Internal Brace™ augmentation.

METHODS:

A prospective study was conducted. Patients were included if they presented medial ankle pain and/or giving way, exhibited asymmetric flexible hindfoot valgus, failed conservative treatment, and had a positive MRI evaluated by an independent radiologist. Patients with stage IV flatfoot deformity, neuropathy and/or inflammatory arthritis were excluded. CDLI was confirmed intraoperatively with the arthroscopic drive-through sign. Patients were evaluated preoperatively and postoperatively using FAAM, SF-36 and grade of satisfaction. Paired t-tests were used to assess FAAM and SF-36 scores variation.

RESULTS:

Thirteen patients met inclusion criteria. No patient was lost to follow-up, with a mean follow-up time of 13.5 months (range 6-21). Preoperative FAAM and SF-36 scores improved from 58.7 to 75.3 and from 60.2 to 84.4 postoperatively, respectively (p<.01). Two implant failures were observed, with no apparent compromise of construct stability. No patient was re-operated.

CONCLUSIONS:

Our results suggest that deltoid ligament repair with Internal Brace™ augmentation in patients with CDLI is a reliable option with good functional outcomes and high satisfaction grade in short term follow-up.

LEVEL OF EVIDENCE:

Level IV.

KEYWORDS:

Ankle instability; Augmentation; Chronic deltoid ligament insufficiency; Internal Brace

PMID:
30478015
DOI:
10.1016/j.fas.2018.10.004

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