{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T01:17:13Z","timestamp":1769563033798,"version":"3.49.0"},"reference-count":43,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012226","name":"Fundamental Research Funds for the Central Universities","doi-asserted-by":"publisher","award":["AF0820060"],"award-info":[{"award-number":["AF0820060"]}],"id":[{"id":"10.13039\/501100012226","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004608","name":"Natural Science Foundation of Jiangsu Province","doi-asserted-by":"publisher","award":["BK20251817"],"award-info":[{"award-number":["BK20251817"]}],"id":[{"id":"10.13039\/501100004608","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>The deltoid ligament (DL) is the primary stabilizer of the medial ankle; however, a limited understanding of the functional roles of its various bundles hinders rational surgical decision-making. This study aims to investigate the roles of individual DL bundles in maintaining ankle stability and articular contact pressure and thus seeks to guide decisions on whether reconstruction is required for specific injuries. A validated finite element foot model was used to simulate isolated and multiple deficiencies in the DL bundle. The articular displacements, rotations, and peak talar cartilage contact pressure were evaluated under anterior drawer force and under internal\u2013external rotation, eversion, and plantarflexion\u2013dorsiflexion moments. Compared with the intact model, anterior tibiotalar ligament (ATTL) deficiency resulted in the greatest anterior drawer displacement (increase: 29%). Talonavicular ligament (TNL) deficiency caused the largest internal\u2013external rotation and plantarflexion (increases in external rotation: 69%; in internal rotation: 10%; in plantarflexion: 32%). Tibiocalcaneal ligament (TCL) deficiency caused the largest eversion (increase: 93%). Deep posterior tibiotalar ligament (dPTTL) deficiency caused the largest dorsiflexion (increase: 68%). The maximum talar cartilage contact pressure occurred in the TNL-deficient model under the plantarflexion condition. In conclusion, individual DL bundles exhibit specific functions in terms of controlling multidirectional ankle stability\u2014the ATTL, TNL, TCL, and dPTTL are the primary stabilizers for anterior translation, rotation\/plantarflexion, eversion, and dorsiflexion, respectively. These findings provide a biomechanical rationale for personalized surgical strategies. When comprehensive DL reconstruction is not feasible, clinicians can prioritize the reconstruction of specific bundles according to the patient\u2019s instability severity and functional demands across degrees of freedom.<\/jats:p>","DOI":"10.3390\/bioengineering13020145","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T11:35:42Z","timestamp":1769513742000},"page":"145","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Role of the Individual Bundles of the Deltoid Ligament in Multidirectional Stability and Articular Contact Pressure of the Ankle Joint: A Finite Element Analysis"],"prefix":"10.3390","volume":"13","author":[{"given":"Yuandong","family":"Li","sequence":"first","affiliation":[{"name":"School of Biomedical Engineering and Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4390-4108","authenticated-orcid":false,"given":"Xiaoxi","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qingqing","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huizhi","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China"},{"name":"Center for Intelligent Medical Equipment and Devices, School of Biomedical Engineering, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China"},{"name":"Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou 215123, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2167-6873","authenticated-orcid":false,"given":"Cheng-Kung","family":"Cheng","sequence":"additional","affiliation":[{"name":"School of Biomedical Engineering and Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai 200030, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1177\/107110070002100607","article-title":"Influence of the interosseous talocalcaneal ligament injury on stability of the ankle-subtalar joint complex--a cadaveric experimental study","volume":"21","author":"Tochigi","year":"2000","journal-title":"Foot Ankle Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1177\/107110070402500908","article-title":"The effect of ankle injury on subtalar motion","volume":"25","author":"Michelson","year":"2004","journal-title":"Foot Ankle Int."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1177\/10711007241241075","article-title":"Biomechanical Effects of Hindfoot Alignment in Supination External Rotation Malleolar Fractures: A Human Cadaveric Model","volume":"45","author":"Seidel","year":"2024","journal-title":"Foot Ankle Int."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2617","DOI":"10.1177\/03635465231181082","article-title":"The Biomechanical Role of the Deltoid Ligament on Ankle Stability: Injury, Repair, and Augmentation","volume":"51","author":"Brady","year":"2023","journal-title":"Am. 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