M J Pellegrini1, N Torres2, N R Cuchacovich3, P Huertas4, G Muñoz5, G M Carcuro6. 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.
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.
Authors: Rae Lan; Eric T Piatt; Ioanna K Bolia; Aryan Haratian; Laith Hasan; Alexander B Peterson; Mark Howard; Shane Korber; Alexander E Weber; Frank A Petrigliano; Eric W Tan Journal: Foot Ankle Orthop Date: 2021-10-20
Authors: Brock T Kitchen; Brendon C Mitchell; Daniel J Cognetti; Matthew Y Siow; Roland Howard; Alyssa N Carroll; Tracey P Bastrom; Eric W Edmonds Journal: Orthop J Sports Med Date: 2022-04-08