0:00

We're on the ankle.

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Deltoid.

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Good news, bad news.

0:05

Bad news.

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It's complex.

0:08

Good news.

0:10

Even when it's injured, we

0:11

we hardly ever operate on it.

0:13

Remember when you invert the foot,

0:16

you're going to compress the deltoid.

0:18

The deltoid is going to swell from

0:21

this accordion of compression.

0:24

And you don't want to be operating on something

0:27

like that, which is actually a contusive

0:30

phenomenon rather than a distractive phenomenon.

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And even if it is cut, most of

0:36

the time is not operated on.

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So, you don't have to get particularly

0:41

upset about the nuances of deltoid injuries.

0:45

That being said,

0:47

let's still dive into the nuances.

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I'm gonna start out by showing you a ligament.

0:54

The ligament does not come

0:56

from the actual ankle joint.

0:58

It's right here.

1:00

I've drawn it in blue, and it's known as

1:02

the superior calcaneonavicular ligament.

1:08

Now, the reason this is important is because

1:10

the medial collateral is going to have

1:13

a ligament to strut that attaches to it.

1:16

In other words, there's going to be from up

1:19

here to down here, a ligamentous attachment.

1:23

Now that being said, I hate to do this to you,

1:26

but I have to.

1:28

There's a smaller ligament

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that parallels it underneath.

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It's a little bit thinner.

1:32

It's called the medial oblique

1:34

calcaneofibular ligament.

1:36

And there's even a smaller one beneath that.

1:39

And it's called the inferior plantar

1:42

longitudinal calcaneofibular ligament.

1:45

So there's actually three of them.

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But I'm really only interested

1:48

in this main one up here.

1:50

The superior one.

1:53

Now, let's look at the deep deltoid

1:57

and the superficial deltoid.

1:59

The deep deltoid, it's so easy.

2:02

Let's change color a little bit.

2:04

Let's make it a little thicker.

2:07

And we've got, in the back,

2:09

the posterior deep deltoid.

2:12

We've got, in the front,

2:15

the anterior deep deltoid.

2:17

We're done with the deep.

2:19

Oh, that's easy.

2:20

That's great.

2:22

Okay, now, let's start over again and see what

2:26

else we've got that's layered on top of that.

2:31

We're gonna have a series of ligaments that runs

2:35

from front to back, and we're gonna start out

2:37

with this first one, the tibionavicular ligament.

2:42

So I'm going to make that

2:44

orange, tibionavicular ligament.

2:47

Then, we're going to have a tibiospring ligament.

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The tibiospring ligament,

2:55

we'll make that one blue.

2:56

Since we already made the spring ligament blue,

2:58

there's the spring ligament.

3:00

So it's going to go to the ligament.

3:02

So we've got from the bone to the ligament.

3:06

a ligamentous structure.

3:09

Then after that, let's make

3:11

another color just to be creative.

3:14

We've got the tibiocalcaneal ligament,

3:18

and that one's going to go to the calcaneus.

3:21

It's going to go right back here.

3:24

Then we've got one more in the back,

3:27

and that is going to be the superficial

3:30

posterior tibiotalar ligament.

3:32

Maybe I'll use orange just for consistency,

3:35

and now we've got that. So we've got 1, 2, 3,

3:41

4 superficial ligaments, and 2 very simple,

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what I call KISS, keep it simple, stupid,

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deeper, anterior in green, and posterior

3:51

in orange, deep portions of the deltoid.

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That's the arrangement of the deltoid.

3:57

Now of the superficial ones,

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if I had to give one most favored nation

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status, which one would I pick?

4:05

I'm gonna pick my favorite color, purple.

4:08

It'd be this one.

4:09

It would be the tibiospring ligament.

4:15

Let's look at some MR actual

4:17

cases in a separate vignette.