Journal of Foot and Ankle Surgery - 2026-04-14 - Journal Article
Deltoid Release in Varus Ankle Deformity: Radiographic and Clinical Outcomes Following Total Ankle Arthroplasty.
Kim JY, Ko C, Loitz J, Svidler F, Zhu S, Le K, Tam M, Choung D
Topics
Key Takeaway
Deltoid ligament release during TAA for varus deformity achieves an additional 4.95° of coronal correction versus TAA alone, with equivalent postoperative alignment (2.07° vs 2.84°) maintained through two-year follow-up.
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Summary
This retrospective cohort evaluated whether deltoid ligament release provides durable coronal correction in varus ankle deformity during TAA. Patients with deltoid release had greater baseline deformity (14.88° vs 10.70°) yet achieved equivalent postoperative alignment (2.07° vs 2.84°), with difference-in-differences analysis confirming an additional 4.95° correction attributable to the release. No significant coronal alignment drift occurred between one- and two-year follow-up in either group.
Key Limitation
The 13-patient deltoid release cohort is underpowered to detect differences in revision rate, implant survival, or functional scores, limiting conclusions about clinical rather than radiographic outcomes.
Original Abstract
BACKGROUND
While deltoid ligament release is commonly performed during total ankle arthroplasty (TAA) to assist with correction of varus deformity, its quantitative contribution and durability remain insufficiently defined.
PURPOSE
To evaluate the effectiveness and short-term stability of deltoid ligament release in correcting end-stage ankle arthritis with varus deformity during total ankle arthroplasty.
STUDY DESIGN
Retrospective cohort study.
METHODS
A retrospective review was conducted on 496 patients who underwent TAA by five surgeons between January 2010 and December 2019, with a minimum one-year follow-up. Patients with varus deformity localized to the ankle joint were included and those with neutral or valgus alignment or prior rearfoot fusion were excluded. Immediate postoperative correction and maintenance of coronal alignment were compared between patients with and without deltoid ligament release using two-sample t-tests and difference-in-differences analyses.
RESULTS
Forty-five patients met inclusion criteria, with a mean follow-up of 4.52 ± 2.00 years. Thirteen patients (28.9%) underwent deltoid ligament release and thirty-two patients (71.1%) did not. The deltoid release group demonstrated greater preoperative deformity (14.88° vs. 10.70°, p = 0.040) and achieved a significantly larger mean correction (12.81° vs. 7.86°, p < 0.001). Difference-in-differences analysis showed an additional mean correction of -4.95° (95% CI: -9.03° to -0.87°). Postoperative alignment was similar between groups (2.07° vs. 2.84°, p = 0.403), with no significant coronal alignment changes between one- and two-year follow-up (p > 0.100).
CONCLUSION
Deltoid ligament release is an effective adjunct for achieving and maintaining neutral coronal alignment in severe varus ankle deformities undergoing TAA without rearfoot fusion.
LEVEL OF EVIDENCE
Level III.