Chronic Ankle Sprains (Medial Ankle Instability): Deltoid Ligament Reconstruction Animation

Chronic Ankle Sprains (Medial Ankle Instability): Deltoid Ligament Reconstruction Animation

This animation demonstrates a deltoid ligament reconstruction for the treatment of medial ankle instability. When the ligament cannot be repaired, a tendon graft can be used to reconstruct the ligament to provide stability to the ankle. Here, we see a right ankle. First, an incision is made along the inner side of the ankle, and a drill is used to make a tunnel through the inner ankle bone, called the medial malleolus, which makes up the end of the shinbone, or tibia.

A reamer is then used to widen the start of the tunnel. The tendon graft, which is attached to an adjustable suture device containing a small metal button, is then passed through the tunnel. The small metal button is flipped out of the tunnel to sit on the outside of the shinbone. Additional tension is applied to pull part of the graft into the tunnel, leaving 2 ends sticking out. Next, a drill and reamer are used to make a tunnel in the talus bone of the ankle. A screw is inserted over 1 end of the graft into the tunnel to secure it into the bone.

Then, a drill and reamer are used to make a tunnel in the heel bone, or calcaneus. The other end of the graft is trimmed and prepared with sutures. These sutures may be threaded through another small metal button. The button and sutures are inserted into the tunnel. The sutures are pulled to flip the metal button out of the tunnel to sit on the other side of the heel bone, and the graft end is pulled into the tunnel. A needle is used to secure the graft end at the start of the tunnel, and another screw is used to secure the graft into the bone.

Alternatively, the graft end may be secured to the heel bone with just a screw without the use of another metal button. The graft is tightened by pulling on the sutures exiting from the tunnel made in the shinbone. The sutures are then cut off and the skin incision will be closed with sutures. The deltoid ligament reconstruction is now complete.