Defining the Components of the Deltoid Ligament (DL): A Cadaveric Study

Essam E Ismail,Khwaja Moizuddin,Yasser Al Harbi,Sujata B Bayer,Radi A Al Saffar,Siraj A Shaikh,Sanket D Hiware,Rashid A Aldahhan,Syed R Daimi,Kamaluddin Motawei

doi:10.7759/cureus.23051

Abstract

Background: The deltoid ligament (DL) is a strong triangle-shaped ligament with a complex fascicular arrangement. Understanding the morphological and/or functional typing of the DL structure is hindered by a paucity of clear, quantitative, and reproducible data and is further complicated by inconsistent terminology use. The aim of this work was to describe different components of the DL using strict identification criteria.Methods: Thirty embalmed cadaveric ankles of both sides were dissected on all sides and studied by using gross examination, micro-dissection, and light microscopy by tracing the fascicular pattern of each under 6X magnification.Results: Six ligamentous bands were identified. The tibiotalocalcaneal ligament (TTC) and the superficial posterior tibiotalar ligament (sPTT) were two superficial variants and the anterior tibiotalar ligament (ATT), the anterior tibiotalonavicular ligament (ATTN), the intermediate tibiotalar ligament (ITT), and the deep posterior tibiotalar ligament (dPTT) were four deep variants. The TTC was identified in all 30 embalmed cadaveric specimens. Five additional ligamentous bands (ITT, sPTT, dPTT, ATT, and ATTN) were variable findings in the current cohort.Conclusion: This study presents six ligamentous bands as a regular finding and five additional ligamentous bands as variable findings in the dissected specimen. This data could assist in the radiological diagnosis of DL injuries and advanced procedures related to its surgical repair and reconstruction.

Highlights

The deltoid ligament (DL) is a strong, broad ligament with a complex fascicular arrangement
This nomenclature has been modified by the research group to describe the extension of some fibers to new attachment as in anterior tibiotalonavicular ligament (ATTN), which considered the novelty of this article
The present study provides details about the bony attachments of the different bands of DL, that could assist in the radiological diagnosis of DL injuries and advanced procedures related to its surgical repair and reconstruction

Summary

Introduction

The deltoid ligament (DL) is a strong, broad ligament with a complex fascicular arrangement. It spans from the medial malleolus to the calcaneus, navicular, and talus bones, thereby creating a triangular shape. Previous qualitative and quantitative observations have demonstrated that this ligament is a significant stabilizer of both the medial tibiotalar joint and the entire tibiotalocalcaneal joint complex [1,2]. The commonly accepted view is that the DL consists of two layers: a superficial layer and a deep layer. The superficial layer restricts the propensity of the talus to move into a valgus position, resisting eversion of the hind foot, whereas the deep layer is the principal restraint of the talus against external rotation [4,5]. The deltoid ligament (DL) is a strong triangle-shaped ligament with a complex fascicular arrangement. The aim of this work was to describe different components of the DL using strict identification criteria

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Discussion

Conclusion