Presentations

Abstract

Introduction:

The purpose of this systematic review and meta-analysis was to compare clinical outcomes, complications, and failures between patients who underwent deltoid repair (DR) and those who did not (non-DR) during ankle fractures. In addition, we devised an evidence-based treatment algorithm to help guide decision-making for the indication of deltoid ligament repair in ankle fractures.

Methods:

During July 2023, the Medline, Embase, and Cochrane library databases were systematically reviewed using the PRISMA guidelines. Fourteen comparative studies comparing outcomes between the DR cohort and non-DR cohort were included. If the heterogeneity was low (I2 < 25%), a fixed effects model was used. If the heterogeneity was moderate-to-high (I2 > 25%), a random effects model was used.

Results:

In total, 402 patients (402 ankles) were in the DR cohort and 503 patients (503 ankles) were in the non-DR cohort. The weighted mean follow-up was 24.1 ± 2.8 months. There were superior AOFAS scores in the DL cohort, but no difference in VAS scores between the 2 cohorts. Superior medial clear space was observed in the DL cohort. No difference in complications was observed between the 2 cohorts, but a higher secondary surgical procedure rate was observed in the Non-DL cohort. We devised a treatment algorithm to help guide decision-making for the indication of deltoid ligament repair in ankle fractures.

Conclusions:

This systematic review demonstrated superior subjective clinical outcomes, and radiographic outcomes together with a lower secondary surgical procedure rate following repair of the deltoid ligament in the setting of ankle fractures. We devised a treatment algorithm to help guide decision-making for the indication of deltoid ligament repair in ankle fractures. However, there was marked heterogeneity and underreporting of data between the included studies, limiting the generation of any robust conclusions.