• Kevin J Campbell, Max P Michalski, Katharine J Wilson, Mary T Goldsmith, Coen A Wijdicks, Robert F LaPrade, and Thomas O Clanton.
• Department of Biomedical Engineering, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657.
• J Bone Joint Surg Am. 2014 Apr 16; 96 (8): e62.

BackgroundThe 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.MethodsThe 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.ResultsIn 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.ConclusionsThe 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.Clinical RelevanceThe 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.

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