Evaluating the Necessity of Deltoid Ligament Repair in Ankle Fractures: A Systematic Review and Meta-Analysis

The deltoid ligament provides medial ankle stability and resists external rotation, excessive pronation, and abduction by anchoring the medial malleolus of the tibia to the surrounding tarsal bones. It is frequently disrupted in ankle fractures, for which optimal management remains debated. This systematic review and meta-analysis evaluated the current evidence comparing surgical repair versus non-repair of the deltoid ligament in adult patients with ankle fractures. A comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library identified prospective randomized controlled trials, with study selection conducted using Covidence by two independent reviewers, with a third reviewer resolving discrepancies. Five studies met the inclusion criteria and reported outcomes, including functional outcomes, postoperative complications, and return-to-work timelines. Meta-analysis demonstrated no significant difference in functional outcomes between repair and non-repair groups (mean difference (MD): 4.57; 95% confidence interval (CI): -3.03 to 12.17; p = 0.24) or return-to-work time (risk ratio (RR): 1.02; 95% CI: 0.65-1.60; p = 0.93); however, complication rates were significantly lower in patients undergoing deltoid ligament repair (RR: 0.43; 95% CI: 0.24-0.77; p = 0.004). While functional outcomes were comparable, deltoid ligament repair was associated with a reduced risk of postoperative complications, suggesting a potential benefit in selected patients, although larger randomized trials are needed to further define its role in ankle fracture management.