A systematic review on diagnosing deltoid ligament injuries— are we missing a uniform standard?

Review written by Dr Chris Bleakley info

Key Points

  1. Stress radiography remains the most commonly used diagnostic approach for assessing deltoid ligament injuries, yet there is substantial variation in medial clear space thresholds for surgical intervention.
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BACKGROUND & OBJECTIVE

The deltoid ligament stabilizes the medial ankle, comprising deep and superficial layers. It maintains talar alignment by preventing excessive lateral or rotational movement. Despite its critical role, there are few guidelines for assessing acute deltoid ligament injuries and severity is difficult to quantify without invasive arthroscopy.

Accurately assessing deltoid ligament integrity is crucial, as severe injuries may benefit from surgical repair (1). Several diagnostic tests exist, but some (e.g. tap test, gravity test) are primarily intraoperative rather than suited for acute clinical evaluation.

This systematic review by Schrempf et al. examined current diagnostic approaches and aimed to identify a standardized clinical method for assessing deltoid ligament instability.

The deltoid ligament stabilizes the medial ankle, comprising deep and superficial layers.
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Stress tests (e.g. talar tilt, valgus stress, external rotation) primarily confirm frank instability and should not be used to rule out injury.

METHODS

  • A systematic search of online databases (up to February 2022), grey literature, and reference lists was conducted.
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