Management of Patellar Tendon and Deltoideum Ligament Avulsion

Initial Evaluation and Imaging

The American College of Radiology recommends radiographs of the ankle as the initial study to evaluate deltoideum ligament injury, with a sensitivity of 96% and specificity of 98% for deep ligamentous lesions compared to arthroscopy 1, 2
In cases where ankle radiographs are normal but clinical suspicion of ligamentous injury persists, MRI is the next appropriate study, as it can detect associated lesions and has a high sensitivity and specificity for ligamentous injuries 1, 2, 3

The American College of Radiology suggests that the degree of instability in stress tests under anesthesia should guide the decision to address all lesions in one surgical time or in two stages, with a focus on prioritizing the reconstruction of the extensor mechanism first 3

The American College of Radiology recommends augmented repair of the anterior component only for complete deltoideum ligament rupture, as it introduces significant anterior translation, external rotation, and eversion, and augmented repair is sufficient to stabilize the rupture 1, 3
Augmented repair of the deltoideum ligament may reduce or avoid the need for prolonged postoperative immobilization, promote accelerated rehabilitation, and prevent stiffness, allowing for an earlier return to pre-injury activity 1