Deltoid complex anatomy

NewsBot · Nov 2, 2016

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The Morphology and Prevalence of the Deltoid Complex Ligament of the Ankle
A Meta-analysis of Cadaveric Studies
Kaissar Yammine, MD, MPH, PhD
Foot Ankle Spec November 1, 2016

The deltoid ligament is a complex structure of the tibiotalar joint that limits the translation and tilting of the talus. It is often associated with injuries of the ankle joint. The deltoid complex ligament has 2 layers; one superficial with 4 bands and the other deep with 2 bands. Nevertheless, the prevalence and size of its components are reported with some variability in the literature. The aim of this meta-analysis is to generate weighted values of the prevalence, size, and attachment surface areas of its components. Eight studies met the inclusion criteria with a total of 142 ankle specimens. The analyses demonstrate that the most consistent component is the deep posterior tibiotalar (100%), followed by the tibiospring (≈94%), the tibionavicular (≈90%), and the tibiocalcaneal (85%). The superficial posterior ligament and the deep anterior tibiotalar ligament were the least prevalent (≈80% and ≈63%, respectively). The longest ligament was found to be the tibionavicular ligament and the shortest band was the deep posterior tibiotalar ligament. The tibionavicular ligament was the thinnest of all deltoid complex ligament components. This study yielded more accurate data on the frequency and size of its components. The possible absence of a component, particularly of the superficial layer, might compromise joint stability in acute ankle injuries.
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NewsBot · Apr 28, 2017

The Arterial Anatomy of the Deltoid Ligament: A Cadaveric Study
Jacob A. Haynes, MD, Michelle Gosselin, MD, Brian Cusworth, MS, Jeremy McCormick, MD, Jeffery Johnson, MD, Sandra Klein, MD
Foot & Ankle International April 27, 2017

Background:
There is an increasing interest in the operative treatment of deltoid ligament disruption in the setting of chronic ankle instability. Understanding the vascular anatomy of the deltoid complex is beneficial when considering operative procedures on the medial ankle and may provide insight into factors that lead to chronic deltoid insufficiency and ankle instability.

Methods:
Thirty-two pairs of cadaveric specimens (64 total legs) were amputated below the knee, and the tibialis anterior, tibialis posterior, and peroneal arteries were injected with India ink and Ward’s blue latex. Specimens then underwent chemical debridement to identify the vascular supply to the deltoid ligament. A subset of specimens also underwent intraosseous debridement using the modified Spalteholz technique.

Results:
The vascular supply to the deltoid ligament was clearly visualized in 60 (93.8%) specimens. Fifty-eight specimens (96.7%) had arterial supply with an origin from the medial tarsal artery, 57 specimens (95%) had supply from the tibialis posterior artery, and 23 (38.3%) specimens had supply from the tibialis anterior artery. All specimens had at least 1 location of intraosseous vascular supply, either at the medial malleolus or medial talus.

Conclusion:
There were 3 separate extraosseous sources and 2 intraosseous sources of vascular supply to the deltoid ligament.

Clinical Relevance:
Knowledge of the vascular supply may aid in identifying factors that predispose a subset of patients with medial ankle sprains to failure of conservative treatment, as well as provide useful anatomic information when considering operative treatment for chronic ankle instability.
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NewsBot · May 1, 2020

The tibiocalcaneal bundle of the deltoid ligament – prevalence and variations
FranciscoGuerra-PintoaAlirioFabianbTiagoMotacTaniaDíazdMarianoMonzoeXavier MartinOlivaf
Foot and Ankle Surgery

Highlights
•The precise anatomy of the different bundles of the deltoid ankle ligament has different descriptions and nomenclatures.
•The literature reports highly variable frequency for the tibiocalcaneal ligament.
•The purpose of this research is to access the deltoid's tibiocalcaneal ligament morphology in a large anatomical study as well as to put the previous anatomical series into.
•The tibiocalcaneal ligament was identified in 33 (77%) of 43 ankle specimens.
•In the 10 ankles in which it could not be identified we report a tibiospring ligament variant with fibers spanning the gap between the tibiospring ligament and the sustentaculum tali.
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NewsBot · May 11, 2020

Strain pattern of each ligamentous band of the superficial deltoid ligament: a cadaver study
Masato Takao, Satoru Ozeki, Xavier M. Oliva, Ryota Inokuchi, Takayuki Yamazaki, Yoshitaka Takeuchi, Maya Kubo, Danielle Lowe, Kentaro Matsui, Mai Katakura, Ankle Instability Group & Mark Glazebrook
BMC Musculoskeletal Disorders volume 21, Article number: 289 (2020)

Background
There are few reports on the detailed biomechanics of the deltoid ligament, and no studies have measured the biomechanics of each ligamentous band because of the difficulty in inserting sensors into the narrow ligaments. This study aimed to measure the strain pattern of the deltoid ligament bands directly using a Miniaturization Ligament Performance Probe (MLPP) system.

Methods
The MLPP was sutured into the ligamentous bands of the deltoid ligament in 6 fresh-frozen lower extremity cadaveric specimens. The strain was measured using a round metal disk (clock) fixed on the plantar aspect of the foot. The ankle was manually moved from 15° dorsiflexion to 30° plantar flexion, and a 1.2-N-m force was applied to the ankle and subtalar joint complex. Then the clock was rotated every 30° to measure the strain of each ligamentous band at each endpoint.

Results
The tibionavicular ligament (TNL) began to tense at 10° plantar flexion, and the tension becomes stronger as the angle increased; the TNL worked most effectively in plantar flex-abduction. The tibiospring ligament (TSL) began to tense gradually at 15° plantar flexion, and the tension became stronger as the angle increased. The TSL worked most effectively in abduction. The tibiocalcaneal ligament (TCL) began to tense gradually at 0° dorsiflexion, and the tension became stronger as the angle increased. The TCL worked most effectively in pronation (dorsiflexion-abduction). The superficial posterior tibiotalar ligament (SPTTL) began to tense gradually at 0° dorsiflexion, and the tension became stronger as the angle increased, with the SPTTL working most effectively in dorsiflexion.

Conclusion
Our results show the biomechanical function of the superficial deltoid ligament and may contribute to determining which ligament is damaged during assessment in the clinical setting.
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NewsBot · Jul 15, 2020

The Attachment Sites and Attachment Areas of Deltoid Ligament Related to Clinical Implications: A Cadaveric Study.
Chanatporn Inthasan; Yasuhito Tanaka; Tanawat Vaseenon; Pasuk Mahakkanukrauh
International Journal of Morphology . ago2020, Vol. 38 Issue 4, p1106-1111. 6p.

Currently, the treatment for patients with deltoid ligament injuries who require surgical treatment are anatomical repair and reconstruction. The clinicians should understand the exact knowledge of attachment areas of individual bands of deltoid ligament for a successful treatment. We studied 46 ankles of fresh frozen cadavers. The individual bands of deltoid ligament were divided to small fibers. Afterwards, each small fiber of each band was cut and marked with acrylic color on the origin and insertion followed by photo taking. Lastly, the photos of individual origin and insertion were used to calculate the attachment areas. We found six bands of deltoid ligament in all ankles except tibionavicular ligament. Moreover, we discovered deep to tibiocalcaneal and posterior to sustentaculum tali ligaments in 3 cases. Regarding the attachment area, the deep posterior tibiotalar ligament had the largest proximal and distal attachment areas which were 87.36±23.15 mm2 and 88.88±24.24 mm2, respectively. The anterior tibiotalar ligament had the least proximal and distal attachment areas which were 23.12±8.25 mm2 and 33.16±14.63 mm2, respectively. Hence, the accuracy and exact areas of attachment of deltoid ligament are important as it can help clinicians to select the suitable treatments including injury prevention.
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NewsBot · Feb 1, 2022

Length change pattern of the ankle deltoid ligament during physiological ankle motion
ShengxuanCaoChenWangChaoZhangJiazhangHuangXuWangXinMa
Foot and Ankle Surgery; 15 January 2022

Background
Length change pattern of the ankle deltoid ligament during physiological ankle motion is still confused currently and had not been studied in vivo.

Methods
The deltoid ligaments from 7 cadaveric specimens were dissected. Lengths of each band during 30° plantarflexion to 20° dorsiflexion were measured. A dual fluoroscopy imaging system was utilized to capture the images of hindfoot joint of 7 healthy subjects during the stance phase of walking. 3D bone models were reconstructed from CT images. Lengths of each band were calculated after model-image registration utilizing a solid modeling software. Percentage of length variation and poses when the bands were in maximum extension were documented among each band.

Results
The anterior border of tibiocalcaneal ligament (TCL) had only 1.7% length variation in vitro and 5.7% length variation in vivo. The tibionavicular ligament, tibiospring ligament, and deep anterior tibiotalar ligament were in maximum extension at 30° plantarflexion, however, superficial posterior tibiotalar ligament, deep posterior tibiotalar ligament, and the posterior border of TCL were in maximum extension at 20° dorsiflexion. The tibionavicular ligament, tibiospring ligament, and deep anterior tibiotalar ligament were in maximum extension during foot flat. The TCL was in maximum extension during midstance. The superficial posterior tibiotalar ligament and deep posterior tibiotalar ligament were in maximum extension during heel off and toe off.

Conclusion
The length of TCL did not change during ankle dorsiflexion and plantarflexion. The bands anterior to and posterior to the TCL showed different length change pattern during physiological ankle dorsiflexion and plantarflexion
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NewsBot · Apr 4, 2022

A Preliminary Study to Assess the Relevance of Shear-Wave Elastography in Characterizing Biomechanical Changes in the Deltoid Ligament Complex in Relation to Ankle Position
Grégoire Rougereau, MD, Thibault Marty-Diloy, MD, Marie Vigan, PhD, ...
Foot & Ankle International April 2, 2022

Background:
The purpose of this study was (1) to evaluate the biomechanical properties of the different bundles of the deltoid ligament in various ankle positions in a cohort of healthy adult volunteers; (2) describe the impact of demographic and hindfoot morphology characteristics on their stiffness; (3) to assess the reliability and reproducibility of these measurements.

Methods:
Deltoid ligament complex of both ankles were assessed by shear-wave elastography (SWE) in 20 healthy patients resting on hinge support. The propagation shear-wave speed (SWS) in ligaments was measured, which is related to the tissue’s elastic modulus. The following ligaments were analyzed in a neutral position and then in varus, valgus, dorsal, and plantar flexions: tibionavicular ligament (TNL), tibiocalcaneal ligament (TCL), the superficial posterior tibiotalar ligament (SPTL), the anterior tibiotalar ligament (ATTL), and the deep posterior tibiotalar ligament (DPTTL).

Results:
The mean SWS increased between neutral and 20 degrees valgus position for TCL (4.08 ± 0.78 m/s vs 5.56 ± 0.62 m/s, respectively; P < .0001) and for DPTTL (2.58 ± 0.52 m/s vs 3.59 ± 0.87 m/s, respectively; P < .0001). The mean SWS increased between neutral and 30 degrees plantarflexion for ATTL (2.11 ± 0.44 m/s vs 3.1 ± 0.5 m/s, respectively; P < .0001) and TNL (2.96 ± 0.66 m/s vs 4.99 ± 0.69 m/s, respectively; P < .0001). The mean SWS increased between neutral and 20 degrees dorsal flexion for SPTL (4.2 ± 1 m/s vs 5.45 ± 0.65 m/s, respectively; P < .0001).

Women had less DPTTL SWS than men in the neutral position (2.37 ± 0.35 m/s vs 2.71 ± 0.49 m/s, respectively; P = .007). Other demographics had no impact on the SWS value of other ligaments. All inter- and intraobserver agreements were good to excellent.

Conclusion:
This study presents a reliable and reproducible SWE measurement protocol to describe the physiological function of all bundles of the medial collateral ligament in healthy adults.

Clinical relevance:
This examination technique can be available to orthopaedic surgeons, allowing reliable and reproducible monitoring of the SWS of the various ligaments constituting the medial collateral plane. The biomechanical values described in this study may give insight into in what position medial ankle ligament reconstruction should be tensioned.
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Deltoid complex anatomy

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Deltoid complex anatomy

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Deltoid Sprain vs. Acute Navicular Fracture

Deltoid Lig Pain

Deep Deltoid Ligament

Support System of Lisfranc Joint Complex

The Arterial Anatomy of the Lateral Ligament Complex of the Ankle: A Cadaveric Study

‘Complex systems model’ of running-related injury development and prevention

Overcoming a TFCC (Triangular Fibrocartilage Complex) injury of the wrist as a practicing Podiatrist

Share This Page

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