Deltoid ligament repair is not necessary in patients with bimalleolar equivalent ankle fractures

Previous meta-analyses have shown that systematic deltoid repair (DR) in patients with bimalleolar equivalent ankle fractures improves post-operative functional outcomes and reduces reoperations. However, these studies were retrospective and are subject to the biases inherent in the nature of observational studies. Therefore, by including only randomized controlled trials (RCTs), this meta-analysis will assess the benefits of DR in these patients. Following the PRISMA guidelines, PubMed, Embase, Cochrane, and Google Scholar were accessed and explored until November 2025. The extracted data consisted of the risk of complications, post-operative and improvement in medial clear space (MCS), operative time, post-operative pain and post-operative American Orthopedic Foot and Ankle Society (AOFAS) score. Five RCTs were included, consisting of 244 patients, with 121 in the DR group and 123 in the control group. There was no difference between the two groups in adverse events. In addition, there were no differences in post-operative MCS, pain, or AOFAS between the two groups. However, the control group had a shorter operative time (Mean Difference = 46.75 min, p = 0.05). The results of this meta-analysis revealed that systematic DR did not have additional benefits in patients with bimalleolar equivalent ankle fractures. Future studies are needed in order to figure out the characteristics of patients that benefit from DR in this type of ankle fractures.