Deltoid ligament injury

Case contributed by Wajahat Ali Mohammed

Presentation

Left ankle pain for 6 weeks after sustaining a jumping injury upon landing during a basketball game

Patient Data

Age: 25 years
Gender: Male
x_ray

Frontal standing radiograph of the ankle with normal findings. Retrospectively this study may reveal an avulsion fracture of the medial malleolus. 

mri

The MRI findings above reveal a complete tear of the deep deltoid ligament, both anterior and posterior components. Other findings in the MRI study included a complete tear of the anterolateral talofibular ligament, a low-grade sprain of the calcaneofibular ligament, marrow edema in the tip of the lateral malleolus, and a moderate ankle joint effusion.

Case Discussion

This patient presented with ankle pain and inability to bear weight after landing on it while playing basketball. After physical therapy for 6 weeks with no improvement, MRI revealed a tear of the deep portion of the deltoid ligament. The deltoid ligament is the strongest ligament of the ankle joint; it is subdivided into the superficial and deep layers. The superficial layer helps provide stability by opposing the external rotation of the talus. The deep layer helps provide stability by preventing posterior translation of the talus in addition to valgus and lateral movement 1

In this case, the patient had a deltoid ligament injury more precisely a tear of the deep layer. Of note, the posterior component is the strongest component of the deltoid ligament 3. Further management for this patient includes RICE therapy (rest, ice, compression, and elevation) and physical therapy for the acute phase 2.

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