Functional and radiographic outcomes of deltoid ligament reconstruction for chronic medial ankle ligament insufficiency: A systematic review

PURPOSE: Chronic deltoid ligament insufficiency contributes to medial ankle instability, potentially coexisting with lateral instability or peritalar deformity. The optimal reconstruction strategy remains unclear. METHODS: A systematic review following PRISMA 2020 guidelines searched MEDLINE, Embase and Scopus for studies reporting outcomes of deltoid ligament reconstruction for chronic insufficiency. The review was prospectively registered on PROSPERO (CRD420251269123). Functional scores, radiographic stability and complications were extracted. Risk of bias was assessed using ROBINS-I. RESULTS: Fourteen studies (324 patients, 329 ankles; mean follow-up 29.2 months) were included. Most were retrospective with moderate-to-serious risk of bias. Reconstructions included direct repair, tendon graft reconstruction and synthetic augmentation, predominantly via open approaches. Postoperative AOFAS scores and talar tilt measurements were consistently improved. Complications were predominantly transient sensory neuropraxias. CONCLUSION: Deltoid reconstruction was associated with improved pain and function in both isolated ligamentous instability and adult-acquired flatfoot, although in the latter it was performed as part of a combined realignment. Radiographic correction was modest in isolated instability and larger in flatfoot, where concurrent osseous procedures were performed. Comparative trials using validated outcome measures are needed to define indications, techniques, and durability.