The role of deltoid ligament repair in Weber B and C ankle fractures: A systematic review and meta-analysis of clinical, functional and radiographic results.

Abstract

The indications for deltoid ligament (DL) repair in ankle fractures are not well-defined. This meta-analysis aims to evaluate clinical, radiographical, and functional outcomes related to DL repair in ankle fractures. Following Cochrane and PRISMA guidelines, a comprehensive literature search was conducted across Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMed, Embase, Scopus, Science Citation Index Expanded (Web of Science), ScienceDirect, CINAHL, and LILACS from January 1, 1990, to June 1, 2024. Inclusion criteria encompassed level I to IV comparative studies of Weber B and/or C fractures with DL rupture, while level V studies were excluded. A total of 10 studies involving 585 patients were analyzed, with 258 undergoing DL repair and 327 receiving conservative treatment (no repair). The mean age of participants was 39.97 years, with a follow-up period averaging 23 months. The DL repair did not show a significant improvement in the AOFAS score as the primary outcome (p = 0.30). However, excluding the study by Jones et al. revealed a significant benefit in AOFAS scores at final follow-up (p = 0.02). Pain reduction assessed by the Visual Analog Scale (VAS) showed no significant difference (p = 0.22), nor did the infection rate (p = 0.68). Furthermore, patients with DL repair experienced significantly fewer reoperations for ankle instability (OR=0.08; p < 0.001) and exhibited a significant reduction in medial clear space on X-ray (MD=-0.45 mm; p < 0.001). This analysis provides updated evidence on DL management in Weber B and C fractures, indicating fewer reoperations and better radiographical outcomes despite a dubtful clinical advantage.