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Updated: Jan 20, 2026

Author Spotlight: Implementing the Enhanced Recovery After Surgery Concept in Rehabilitation Following Anterior Cruciate Ligament Reconstruction
Published on: March 1, 2024
Anatomic Syndesmotic and Deltoid Ligament Reconstruction with Flexible Implants: A Technique Description
Christina J Hajewski1, Kyle Duchman1, Jessica Goetz1
1University of Iowa Hospitals and Clinics, Iowa City, IA USA.
Abstract:
The optimal fixation method for unstable syndesmosis (SYN) injuries remains a matter of debate between rigid screw fixation that stabilizes all three components of the syndesmosis but prohibits any motion, and flexible implants stabilizing by compression along the axis of the interosseous ligament. More recently additional repairs of the anterior or posterior SYN ligaments have been explored both clinically and biomechanically. The role for deltoid ligament (DL) repair or reconstruction in the setting of SYN injury remains controversial. However, the DL is increasingly recognized as having an important contribution to rotational stability of the ankle. A method of treatment is presented for unstable SYN injuries with flexible implants. An anatomic approach to reconstructing the DL with specific augmentation of the anterior and posterior bands of the deep deltoid ligament (DDL) is described for immediate restoration of medial ankle rotational stability. Level of Evidence: V.
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