title: Reconstruction of the chronically failed deltoid ligament: a new technique.
abstract: BACKGROUND
  Chronic deltoid ligament insufficiency that results in valgus tilt of the talus within the ankle mortise (stage IV adult acquired flatfoot) represents a difficult and so far unsolved problem in foot and ankle surgery. If left uncorrected, the deltoid failure with malalignment predisposes to early ankle arthritis and the need for ankle arthrodesis or possibly ankle arthroplasty.
  
  
  METHODS
  Five consecutive patients with deltoid ligament insufficiency resulting in a valgus tilt were treated with a deltoid reconstruction. Reconstruction of the deltoid ligament was done by passing a peroneus longus tendon graft through a bone tunnel in the talus from lateral to medial and then through a second tunnel from the tip of the medial malleolus to the lateral tibia.
  
  
  RESULTS
  At a minimum 2-year followup, all patients had correction of the talar tilt. One patient had 9 degrees of valgus tilt remaining compared to 15 degrees preoperatively, and the procedure was considered a failure. The remaining four patients had correction of the valgus tilt to 4 degrees or less.
  
  
  CONCLUSIONS
  Although not uniformly successful, deltoid ligament reconstruction using a tendon graft through appropriate bone tunnels can reconstruct the deltoid ligament and correct the valgus talar tilt. Successful results were achieved when combined with correction of flatfoot deformity, which is considered a necessary part of the procedure.
authors.affiliation: Hospital for Special Surgery, 523 East 72nd Street, 5th floor, New York, NY 10021, USA. delandj@hss.edu
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Deland
authors.forename: Richard J
authors.initials: RJ
authors.lastname: de Asla
authors.forename: Ayal
authors.initials: A
authors.lastname: Segal
mesh_terms: D000843:Ankle Joint / Q000601:surgery*; D002908:Chronic Disease; D017885:Collateral Ligaments / Q000601:surgery*; D003131:Combined Modality Therapy; D005413:Flatfoot / Q000601:surgery*; D005500:Follow-Up Studies; D005531:Foot Deformities, Acquired / Q000601:surgery*; D006801:Humans; D007592:Joint Diseases / Q000503:physiopathology / Q000601:surgery*; D013710:Tendons / Q000637:transplantation*; D016896:Treatment Outcome