title: The ligament anatomy of the deltoid complex of the ankle: a qualitative and quantitative anatomical study.
abstract: BACKGROUND
  The deltoid ligament has both superficial and deep layers and consists of up to six ligamentous bands. The prevalence of the individual bands is variable, and no consensus as to which bands are constant or variable exists. Although other studies have looked at the variance in the deltoid anatomy, none have quantified the distance to relevant osseous landmarks.
  
  
  METHODS
  The deltoid ligaments from fourteen non-paired, fresh-frozen cadaveric specimens were isolated and the ligamentous bands were identified. The lengths, footprint areas, orientations, and distances from relevant osseous landmarks were measured with a three-dimensional coordinate measurement device.
  
  
  RESULTS
  In all specimens, the tibionavicular, tibiospring, and deep posterior tibiotalar ligaments were identified. Three additional bands were variable in our specimen cohort: the tibiocalcaneal, superficial posterior tibiotalar, and deep anterior tibiotalar ligaments. The deep posterior tibiotalar ligament was the largest band of the deltoid ligament. The origins from the distal center of the intercollicular groove were 16.1 mm (95% confidence interval, 14.7 to 17.5 mm) for the tibionavicular ligament, 13.1 mm (95% confidence interval, 11.1 to 15.1 mm) for the tibiospring ligament, and 7.6 mm (95% confidence interval, 6.7 to 8.5 mm) for the deep posterior tibiotalar ligament. Relevant to other pertinent osseous landmarks, the tibionavicular ligament inserted at 9.7 mm (95% confidence interval, 8.4 to 11.0 mm) from the tuberosity of the navicular, the tibiospring inserted at 35% (95% confidence interval, 33.4% to 36.6%) of the spring ligament's posteroanterior distance, and the deep posterior tibiotalar ligament inserted at 17.8 mm (95% confidence interval, 16.3 to 19.3 mm) from the posteromedial talar tubercle.
  
  
  CONCLUSIONS
  The tibionavicular, tibiospring, and deep posterior tibiotalar ligament bands were constant components of the deltoid ligament. The deep posterior tibiotalar ligament was the largest band of the deltoid ligament.
  
  
  CONCLUSIONS
  The anatomical data regarding the deltoid ligament bands in this study will help to guide anatomical placement of repairs and reconstructions for deltoid ligament injury or instability.
authors.affiliation: Department of Biomedical Engineering, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Campbell
authors.affiliation: Department of Biomedical Engineering, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657.
authors.forename: Max P
authors.initials: MP
authors.lastname: Michalski
authors.affiliation: Department of Biomedical Engineering, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657.
authors.forename: Katharine J
authors.initials: KJ
authors.lastname: Wilson
authors.affiliation: Department of Biomedical Engineering, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Goldsmith
authors.affiliation: Department of Biomedical Engineering, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657.
authors.forename: Coen A
authors.initials: CA
authors.lastname: Wijdicks
authors.affiliation: The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO 81657. E-mail address for T.O. Clanton: tclanton@thesteadmanclinic.com.
authors.forename: Robert F
authors.initials: RF
authors.lastname: LaPrade
authors.affiliation: The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO 81657. E-mail address for T.O. Clanton: tclanton@thesteadmanclinic.com.
authors.forename: Thomas O
authors.initials: TO
authors.lastname: Clanton
mesh_terms: D000328:Adult; D000842:Ankle / Q000033:anatomy & histology*; D000843:Ankle Joint / Q000033:anatomy & histology*; D002102:Cadaver; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000033:anatomy & histology*; D008297:Male; D008875:Middle Aged