We describe a technique that provides anatomic ligament-to-bone repair of the superficial and deep bundles of the deltoid ligament while reducing the talus toward the medial malleolar facet of the tibiotalar joint with anchor-to-post reinforcement of the ligamentous repair. Newer tenodesis techniques have been described for late reconstruction of both deep and superficial components in patients with stage 4 adult acquired flatfoot deformity. Deep deltoid ligament repair has been described using direct end-to-end repair with sutures, as well as by autograft and allograft tendon reconstruction utilizing various techniques. Most acute repair techniques address the superficial deltoid ligament with direct end-to-end repair, fixation through bone tunnels, or suture anchor repair of avulsion injuries. Neglect of the deltoid ligament in the treatment of ankle injuries may be due to difficulties in diagnosis and lack of an effective method for repair. The role of deltoid ligament repair in these conditions has been limited and its contribution to arthritis is largely unknown. Both superficial and deep components of the ligament can be disrupted with a rotational ankle fracture, chronic ankle instability, or in late stage adult acquired flatfoot deformity. The deltoid ligament is the primary ligamentous stabilizer of the ankle joint. Lack, William Phisitkul, Phinit Femino, John E Although inÂ vivo studies are needed, these results support the suture anchor technique as a viable alternative toĪnatomic deltoid ligament repair with anchor-to-post suture reinforcement: technique tip. Although suture anchor quadriceps tendon repair appears to be a biomechanically superior construct, a clinical study is needed to confirm this technique as a viable alternative to gold standard transosseous techniques. Suture anchor quadriceps tendon repairs had significantly decreased gapping during cyclic loading, but no statistically significant difference in ultimate load to failure when compared with transosseous tunnel repairs. Failure mode for all transosseous specimens but one was pulling the repair through the transosseous tunnel. Failure mode for all suture anchors except one was through the soft tissue. There was no statistically significant difference in ultimate load to failure between the 2 groups (PÂ =. The measured cyclic displacement to the first 100Â N, 50 to 150Â N, 50 to 200Â N, and 50 to 250Â N was significantly less for suture anchors than transosseous tunnels.

Outcome measures included load to failure, displacement at 1st 100Â N load, and displacement after each 10th cycle of loading. Tensile load was applied at a rate of 0.1Â mm/s up to 100Â N after which cyclic loading was applied at a rate of 1Â Hz between magnitudes of 50 to 150Â N, 50 to 200Â N, 50 to 250Â N, and tensile load at a rate of 0.1Â mm/s until failure. After the respective procedures were performed, each patella was mounted into a gripping jig. Suture type and repair configuration were equivalent. Specimens were randomly assigned to either a suture anchor repair of quadriceps tendon group (nÂ = 6) or a transosseous tunnel repair group (nÂ = 6). Dual-energy X-ray absorptiometry measurement was performed to ensure equal bone quality amongst groups. Twelve 'patella-only' specimens were used. To evaluate the biomechanical fixation strength of suture anchor and transosseous tunnel repair of the quadriceps tendon in a standardized cadaveric repair model. Sherman, Seth L Copeland, Marilyn E Milles, Jeffrey L Flood, David A Pfeiffer, Ferris M Biomechanical Evaluation of Suture Anchor Versus Transosseous Tunnel Quadriceps Tendon Repair Techniques.

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