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Syndesmosis and deltoid ligament injuries in the athlete

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Injury to the syndesmosis and deltoid ligament is less common than lateral ligament trauma but can lead to significant time away from sport and prolonged rehabilitation. This literature review will discuss both syndesmotic and deltoid ligament injuries without fracture in the professional athlete.

Methods

A narrative review was performed using PUBMED, OVID, MEDLINE and EMBASE using the key words syndesmosis, injury, deltoid, ankle ligaments, and athlete. Articles related to the topic were included and reviewed.

Results

The incidence of syndesmotic injury ranges from 1 to 18 % of ankle sprains. This may be underreported and is an often missed injury as clinical examination is generally not specific. Both MRI and ultrasonography have high sensitivities and specificities in diagnosing injury. Arthroscopy may confirm the diagnosis, and associated intra-articular pathology can be treated at the same time as surgical stabilization. Significant deltoid ligament injury in isolation is rare, there is usually associated trauma. Major disruption of both deep and superficial parts can lead to ankle dysfunction. Repair of the ligament following ankle fracture is not necessary, but there is little literature to guide the management of deltoid ruptures in isolation or in association with syndesmotic and lateral ligament injuries in the professional athlete.

Conclusion

Management of syndesmotic injury is determined by the grade and associated injury around the ankle. Grade I injuries are treated non-surgically in a boot with a period of non-weight bearing. Treatment of Grade II and III injuries is controversial with little literature to guide management. Athletes may return to training and play sooner if the syndesmosis is surgically stabilized. For deltoid ligament injury, grade I and II sprains should be treated non-operatively. Unstable grade III injuries with associated injury to the lateral ligaments or the syndesmosis may benefit from operative repair.

Level of evidence

IV.

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Authors and Affiliations

  1. Chelsea and Westminister Hospital, 369 Fulham Road, London, SW10 9NH, UK

    Graham A. McCollum & James D. F. Calder

  2. Fotrius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK

    Graham A. McCollum & James D. F. Calder

  3. Academic Medical Centre, Department of Orthopaedic Surgery, Orthopaedic Research Centre Amsterdam, Meibergdreef 15, P.O. Box 22660, 1105 AZ, Amsterdam, The Netherlands

    Michel P. J. van den Bekerom, Gino M. M. J. Kerkhoffs & C. Niek van Dijk

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  1. Graham A. McCollum
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McCollum, G.A., van den Bekerom, M.P.J., Kerkhoffs, G.M.M.J. et al. Syndesmosis and deltoid ligament injuries in the athlete. Knee Surg Sports Traumatol Arthrosc 21, 1328–1337 (2013). https://doi.org/10.1007/s00167-012-2205-1

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