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

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

This surgical video demonstrates a reconstruction of the deltoid ligament of the ankle with a tendon graft to treat medial ankle instability. Here, we see a left ankle with the inner side of the ankle facing the screen. The surgeon begins by cutting through the skin and soft tissue at the inner side of the ankle to access the deltoid ligament.

The surgeon locates the inner ankle bone, called the medial malleolus, which makes up the end of the shinbone, or tibia. A drill is positioned into the medial malleolus and used to make a tunnel through the shinbone. The surgeon makes an incision along the front of the shin to allow the drill pin to pass through the front of the shinbone. Next, the surgeon places a reamer over the drill pin and uses it to widen the start of the tunnel.

The tendon graft used in this procedure has already been prepared with sutures. The surgeon passes the graft, folding it in half, through the loop of an adjustable suture device containing a small metal button. The surgeon then passes all of the suture threads through an instrument that is used to pull the sutures through the tunnel made in the shinbone. Tension is applied to pull the metal button out of the tunnel. This metal button will sit on the outside of the shinbone to hold the graft in place.

Additional tension is applied to pull part of the graft into the tunnel, leaving 2 ends sticking out. Each end of the graft will be attached to a different bone to reconstruct different parts of the deltoid ligament. Next, the surgeon uses a drill and reamer to make a tunnel into the talus bone of the ankle, which sits below the end of the shinbone. The surgeon pulls the sutures from 1 end of the graft into the tunnel and out the other side of the ankle.

A screw is then inserted over the end of the graft in the tunnel to secure it into the bone. The surgeon then repeats similar steps to secure the other end of the graft into the inner side of the heel bone, called the calcaneus, which sits below the talus. The surgeon uses a drill and reamer to make a tunnel into the bone. Excess tendon is cut off and sutures are passed through the end of the graft.

The sutures are then used to pull the graft into the tunnel, and a screw is inserted over the end of the graft in the tunnel to secure it into the bone. The sutures exiting from the tunnel in the shinbone are tightened and cut off, and the skin incisions will be closed with sutures. The deltoid ligament reconstruction is complete.