{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T09:17:28Z","timestamp":1787995048657,"version":"build-2784847793"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T00:00:00Z","timestamp":1679875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Ankle fracture combined with deltoid ligament (DL) injury results in decreased stability of ankle mortise, reduced contact surface between tibial and talus, increased local stress, and increased postoperative complications. The purpose of this meta-analysis was to evaluate the postoperative effects of repairing ligaments in ankle fractures with DL rupture.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>According to the steps of the Cochrane systematic review, the related literatures from PubMed, Embase and the Cochrane Library Databases were retrieved as of September 1, 2021, and all relevant randomized controlled trials and retrospective studies were collected. The evaluation indicators include medial clear space (MCS), visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS), complications rate. Meta-analysis was conducted by RevMan\u00ae 5.3 provided by the Cochrane collaboration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 388 patients (195 patients in the ligament repair group and 193 patients in the non-repair group) were included in 7 clinical trials. Meta-analysis data showed there were no statistically significant differences between the ligament repair group and non-repair group in final follow-up VAS, final AOFAS and postoperative MCS (<jats:italic>P<\/jats:italic>\u2009=\u20090.50, <jats:italic>P<\/jats:italic>\u2009=\u20090.04, <jats:italic>P<\/jats:italic>\u2009=\u20090.14, <jats:italic>P<\/jats:italic>\u2009=\u20090.14, respectively). Final follow-up MCS and complications rate in ligament repair group were smaller than those in the non-repair group and were statistically significant (<jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.00001, <jats:italic>P<\/jats:italic>\u2009=\u20090.006, respectively).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Although there was no difference in in final follow-up VAS, final follow-up AOFAS and postoperative MCS between experimental group and control group, It's statistically significant in final follow-up MCS and complications rate. Ligament repair could reduce the width of MCS, restore ankle stability, reduce the incidence of complications and lead to a better prognosis.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2023.976181","type":"journal-article","created":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T05:08:32Z","timestamp":1679893712000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["A meta-analysis of deltoid ligament on ankle joint fracture combining deltoid ligament injury"],"prefix":"10.3389","volume":"10","author":[{"given":"XiaoLing","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianshuang","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronnell D","family":"Dela Rosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhixia","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1302\/0301-620x.82b3.10064","article-title":"Arthroscopic findings in acute fractures of the ankle","volume":"82","author":"Hintermann","year":"2000","journal-title":"J Bone Joint Surg Br"},{"key":"B2","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1007\/s00256-014-1842-5","article-title":"Deltoid ligament in acute ankle injury: mR imaging analysis","volume":"43","author":"Jeong","year":"2014","journal-title":"Skeletal Radiol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1177\/107110079801900504","article-title":"The medial collateral ligaments of the human ankle joint: anatomical variations","volume":"19","author":"Milner","year":"1998","journal-title":"Foot Ankle Int"},{"key":"B4","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1053\/j.jfas.2003.11.005","article-title":"Deltoid ligament integrity in lateral malleolar fractures: a comparative analysis of arthroscopic and radiographic assessments","volume":"43","author":"Schuberth","year":"2004","journal-title":"Journal of Foot & Ankle Surgery"},{"key":"B5","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1097\/00003086-199607000-00043","article-title":"An axially loaded model of the ankle after pronation external rotation injury","volume":"328","author":"Michelson","year":"1996","journal-title":"Clin Orthop Relat Res"},{"key":"B6","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1016\/s1083-7515(03)00147-5","article-title":"Medial ankle instability","volume":"8","author":"Hintermann","year":"2003","journal-title":"Foot Ankle Clin"},{"key":"B7","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1007\/s11751-012-0140-","article-title":"The diagnosis and treatment of deltoid ligament lesions in supination-external rotation ankle fractures: a review","volume":"7","author":"Stufkens","year":"2012","journal-title":"Strategies Trauma Limb Reconstr"},{"key":"B8","first-page":"107","article-title":"Rola modyfikacji potranslacyjnych fibrynogenu w patogenezie zakrzepicyThe role of post-translational modification of fibrinogen in the pathogenesis of thrombosis]","volume":"38","author":"Tadeusiewicz","year":"2015","journal-title":"Pol Merkur Lekarski"},{"key":"B9","doi-asserted-by":"publisher","first-page":"981","DOI":"10.3109\/17453678008990904","article-title":"Ankle fractures: supination-eversion fractures of stage IV. Primary and late results of operative and non-operative treatment","volume":"51","author":"Yde","year":"1980","journal-title":"Acta Orthop Scand"},{"key":"B10","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1016\/S0883-5403(05)80227-X","article-title":"The repair of a ruptured deltoid ligament is not necessary in ankle fractures","volume":"77","author":"Str\u00f6ms\u00f6e","year":"1995","journal-title":"J Bone Joint Surg Br"},{"key":"B11","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/0020-1383(89)90043-0","article-title":"Rupture of the deltoid ligament in ankle fractures: should it be repaired?","volume":"20","author":"Zeegers","year":"1989","journal-title":"Injury"},{"key":"B12","doi-asserted-by":"publisher","first-page":"264","DOI":"10.7326\/0003-4819-151-4-200908180-00135","article-title":"Altman DG; PRISMA group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"151","author":"Moher","year":"2009","journal-title":"Ann Intern Med"},{"key":"B13","article-title":"The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses, Ottawa","author":"Wells","year":"2014","journal-title":"Medicine University of Ottawa"},{"key":"B14","first-page":"580","article-title":"Injuries of the ankle joint, evaluation","volume":"17","year":"1953","journal-title":"Conn State Med J"},{"key":"B15","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1097\/00003086-199008000-00032","article-title":"Talar shift. The stabilizing role of the medial, lateral, and posterior ankle structures","volume":"257","year":"1990","journal-title":"Clin Orthop Relat Res"},{"key":"B16","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1177\/107110078700800104","article-title":"Deltoid ligament: an anatomical evaluation of function","volume":"8","author":"Harper","year":"1987","journal-title":"Foot Ankle"},{"key":"B17","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1177\/107110079001000507","article-title":"The effect of loading on tibiotalar alignment in cadaver ankles","volume":"10","author":"Michelson","year":"1990","journal-title":"Foot Ankle"},{"key":"B18","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1177\/107110079902001110","article-title":"Tibiotalar motion\u2013effect of fibular displacement and deltoid ligament transection: in vitro study","volume":"20","author":"Sasse","year":"1999","journal-title":"Foot Ankle Int"},{"key":"B19","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1016\/0303-8467(95)00071-Q","article-title":"Tibiotalar contact area. Contribution of posterior malleolus and deltoid ligament","volume":"320","author":"Hartford","year":"1995","journal-title":"Clin Orthop Relat Res"},{"key":"B20","doi-asserted-by":"publisher","first-page":"377","DOI":"10.2214\/ajr.162.2.8310930","article-title":"MR Imaging of the ankle: normal and abnormal findings in the medial collateral ligament","volume":"162","author":"Klein","year":"1994","journal-title":"Am J Roentgenol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"36","DOI":"10.3109\/17453678308992867","article-title":"Deltoid ligament. Functional analysis of the medial collateral ligamentous apparatus of the ankle joint","volume":"54","author":"Rasmussen","year":"1983","journal-title":"Acta Orthop Scand"},{"key":"B22","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1177\/107110079601700604","article-title":"Contribution of the deltoid ligament to ankle joint contact characteristics: a cadaver study","volume":"17","author":"Earll","year":"1996","journal-title":"Foot Ankle Int"},{"key":"B23","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1177\/107110079801901109","article-title":"Anatomy of the collateral ligaments of the human ankle joint","volume":"19","author":"Milner","year":"1998","journal-title":"Foot Ankle Int"},{"key":"B24","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/0020-1383(88)90071-x","article-title":"Fracture-dislocation of the ankle with rupture of the deltoid ligament","volume":"19","author":"Johnson","year":"1988","journal-title":"Injury"},{"key":"B25","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1302\/0301-620x.82b3.10064","article-title":"Arthroscopic findings in acute fractures of the ankle","volume":"82","author":"Hintermann","year":"2000","journal-title":"J Bone Joint Surg Br"},{"key":"B26","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/S1697-2198(16)30074-X","article-title":"Resultados de la reparaci\u00f3n quir\u00fargica Del ligamento deltoideo en las fracturas equivalentes bimaleolares","volume":"25","author":"Plazas","year":"2011","journal-title":"Revista del Pie y Tobillo"},{"key":"B27","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1097\/BOT.0b013e31818915d9","article-title":"Posttraumatic ankle osteoarthritis after ankle-related fractures","volume":"23","author":"Horisberger","year":"2009","journal-title":"J Orthop Trauma"},{"key":"B28","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1053\/j.jfas.2014.12.013","article-title":"Repair of the acute deltoid ligament complex rupture associated with ankle fractures: a multicenter clinical study","volume":"54","author":"Yu","year":"2015","journal-title":"J Foot Ankle Surg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"2043015","DOI":"10.1155\/2020\/2043015","article-title":"The importance of the deep deltoid ligament repair in treating supination-external rotation stage IV ankle fracture: a comparative retrospective cohort study","author":"Chen","year":"2020","journal-title":"Biomed Res Int"},{"key":"B30","doi-asserted-by":"publisher","first-page":"652","DOI":"10.2500\/ajra.2013.27.3936","article-title":"Is surgical treatment of deltoid ligament rupture necessary in ankle fractures?","volume":"83","author":"Maynou","year":"1997","journal-title":"Rev Chir Orthop Reparatrice Appar Mot"},{"key":"B31","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1053\/j.jfas.2017.12.007","article-title":"Evaluation of transsyndesmotic fixation and primary deltoid ligament repair in ankle fractures with suspected combined deltoid ligament injury","volume":"57","author":"Wu","year":"2018","journal-title":"J Foot Ankle Surg"},{"key":"B32","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1177\/1071100717732383","article-title":"Short-Term results of a ruptured deltoid ligament repair during an acute ankle fracture fixation","volume":"39","author":"Woo","year":"2018","journal-title":"Foot Ankle Int"},{"key":"B33","doi-asserted-by":"publisher","first-page":"2312","DOI":"10.1016\/j.injury.2018.11.006","article-title":"Does routinely repairing deltoid ligament injuries in type B ankle joint fractures influence long term outcomes?","volume":"49","author":"Sun","year":"2018","journal-title":"Injury"},{"key":"B34","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1053\/j.jfas.2014.12.013","article-title":"Repair of the acute deltoid ligament complex rupture associated with ankle fractures: a multicenter clinical study","volume":"54","author":"Yu","year":"2015","journal-title":"J Foot Ankle Surg"},{"key":"B35","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1186\/s12891-017-1907-4","article-title":"Surgical treatment of ankle fracture with or without deltoid ligament repair: a comparative study","volume":"18","author":"Zhao","year":"2017","journal-title":"BMC Musculoskelet Disord"},{"key":"B36","first-page":"387","article-title":"Suture anchors for primary deltoid 379 ligament repair associated with acute ankle fractures","volume":"85","author":"Shen","year":"2019","journal-title":"Acta Orthop Belg"},{"key":"B37","doi-asserted-by":"publisher","first-page":"714","DOI":"10.1016\/j.fas.2018.11.001","article-title":"Abdelgawad 381 A. Adding deltoid ligament repair in ankle fracture treatment: is it necessary? A systematic review","volume":"25","author":"Dabash","year":"2019","journal-title":"Foot Ankle Surg"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2023.976181\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T05:08:35Z","timestamp":1679893715000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2023.976181\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,27]]},"references-count":37,"alternative-id":["10.3389\/fsurg.2023.976181"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2023.976181","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,27]]},"article-number":"976181"}}