Defining the Components of the Deltoid Ligament (DL): A Cadaveric Study

Essam E Ismail Sr; Radi A Al Saffar; Kamaluddin Motawei; Sanket D Hiware; Khwaja Moizuddin; Siraj A Shaikh; Sujata B Bayer; Yasser Alharbi; Rashid A Aldahhan; Syed R Daimi

doi:10.7759/cureus.23051

Defining the Components of the Deltoid Ligament (DL): A Cadaveric Study

Cureus. 2022 Mar 10;14(3):e23051. doi: 10.7759/cureus.23051. eCollection 2022 Mar.

Affiliations

¹ Anatomy, Imam Abdulrahman Bin Faisal University, Dammam, SAU.
² Anatomy, Imam Abdulrahman Bin Faisal University, Dammam , SAU.
³ Basic Medical Sciences, College of Medicine-Jeddah, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU.

Abstract

Background: The deltoid ligament (DL) is a strong triangle-shaped ligament with a complex fascicular arrangement. Understanding the morphological and/or functional typing of the DL structure is hindered by a paucity of clear, quantitative, and reproducible data and is further complicated by inconsistent terminology use. The aim of this work was to describe different components of the DL using strict identification criteria.

Methods: Thirty embalmed cadaveric ankles of both sides were dissected on all sides and studied by using gross examination, micro-dissection, and light microscopy by tracing the fascicular pattern of each under 6X magnification.

Results: Six ligamentous bands were identified. The tibiotalocalcaneal ligament (TTC) and the superficial posterior tibiotalar ligament (sPTT) were two superficial variants and the anterior tibiotalar ligament (ATT), the anterior tibiotalonavicular ligament (ATTN), the intermediate tibiotalar ligament (ITT), and the deep posterior tibiotalar ligament (dPTT) were four deep variants. The TTC was identified in all 30 embalmed cadaveric specimens. Five additional ligamentous bands (ITT, sPTT, dPTT, ATT, and ATTN) were variable findings in the current cohort.

Conclusion: This study presents six ligamentous bands as a regular finding and five additional ligamentous bands as variable findings in the dissected specimen. This data could assist in the radiological diagnosis of DL injuries and advanced procedures related to its surgical repair and reconstruction.

Keywords: anatomy; anterior tibiotalar ligament; deltoid ligament; intermediate tibiotalar ligament and deep posterior tibiotalar ligament; medial ankle ligaments; superficial posterior tibiotalar ligament; tibiotalocalcaneal ligament.