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Medial Ankle Instability

March 01, 2019

Contributors: James R Holmes, MD; Matthew Pigott, MD; Paul Talusan, MD; David Matthew Walton, MD; Benjamin Lindsey, MD; Benjamin Lindsey, MD

2019 HONORABLE MENTION Ankle sprains are one of the most common musculoskeletal injuries, occurring at a rate of 2.15 to 12.8 cases per 1,000 person-years. Most ankle sprains affect the lateral ligamentous complex, with as few as 5% of ankle sprains affecting the medial ligamentous complex. Despite appropriate rehabilitation, a considerable number of patients who sustain an ankle sprain (as many as 33%) report persistent symptoms of instability. Recent studies have considered the deltoid ligament as the source of this persistent pathology. Surgeons have only recently begun to understand the deltoid ligament, and a paucity of data exists on the management of the deltoid ligament in patients who sustain an ankle sprain. Currently, no established guidelines exist for the management of medial ankle instability. The standard of care mandates a trial of nonsurgical management consisting of physical therapy that includes strengthening and proprioception training, orthotics, and bracing. In patients in whom these nonsurgical treatment measures fail, surgical treatment via anatomic repair with ligament imbrication or secondary reconstruction is warranted. Both repair and reconstruction have demonstrated successful results with resolution of medial instability. Although suture tape has been extensively used to augment repair or reconstruction of the lateral ligamentous complex, it has only recently been used to manage medial ankle instability. With precise technique, repair of the deltoid ligament with augmentation using suture tape may aid in successful resolution of medial ankle instability. This video provides an overview of medial ankle instability. In addition, the video demonstrates repair of a chronic deltoid ligament tear with augmentation using suture tape. The video reviews the epidemiology of, pathology of, diagnosis of, treatment options for, and surgical indications for medial ankle instability. The video discusses the case presentation of a patient with medial ankle instability in whom extensive nonsurgical treatment failed. The patient underwent imbrication of the deltoid ligament with augmentation using suture tape. The rehabilitation protocol and the outcomes of deltoid ligament repair are reviewed. After a technically successful surgery, the patient progressed through a standardized deltoid ligament repair rehabilitation protocol with resolution of symptoms of instability. Deltoid ligament repair with augmentation using suture tape is a successful treatment option for the management of medial ankle instability. Multiple studies have demonstrated good outcomes in patients who undergo surgical repair via this method; however, successful outcomes are predicated on precise surgical technique.

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