0:00

Let's move up now to the medial ligament is complex,

0:04

where indeed there is the deltoid ligament.

0:07

And although there is disagreement with regard

0:11

to all the components of this complex ligament,

0:14

everybody agrees that there is a superficial portion shown

0:19

by the red arrows

0:21

and a deep portion shown by the blue arrows.

0:25

So here is my picture showing you in three dimensions,

0:28

the superficial portion of the deltoid

0:31

and the deep portion of the deltoid.

0:34

Well, let's look at this in more detail.

0:36

I'm showing you now I I something I created

0:40

to show you the medial maus with the anulus,

0:45

the inter canicular groove

0:47

and the posterior colliculus to that particular image.

0:52

Let us now add the deep portion

0:55

of the deltoid ligament, which consists of deep

1:00

tibio Taylor fibers.

1:02

The constant part is the posterior deep

1:05

tibio Taylor ligament.

1:07

It is a very important ligament.

1:09

It is the strongest part of the deltoid ligament.

1:13

The anterior LIG fibers that run from the uh,

1:18

tibia to the Payless are not present in everyone.

1:24

All right, but you may be able to see

1:26

that component as well.

1:28

So these are the two components of the deep portion

1:32

of the deltoid ligament.

1:34

Now I show you in this particular drawing,

1:38

I've added the superficial portion,

1:40

which is a broad ligament with many attachments.

1:45

Some people suggest there is a HA attachment

1:48

that is very variable.

1:50

The next one we deal with is the tibial navicular portion.

1:55

Then we have a tibial spring component,

1:58

a tibial sustentacular component.

2:01

And then in some persons we will have

2:04

a posterior superficial tibial table component.

2:08

So if you go back to a section through the medial malis,

2:13

here's the interocular groove, the posterior colliculus

2:17

that is deep deltoid.

2:20

This is the superficial portion of the deltoid,

2:23

which attaches mainly to the anulus

2:27

of its various components.

2:29

That component attaching to the sust tum is said

2:33

to be the strongest.

2:36

So let's look at some images now to try

2:38

to see if we can figure out what part of the deloid.

2:41

Here we're looking at a coronal image fairly

2:44

far posteriorly.

2:45

This is the posterior,

2:48

a deep posterior tibial Taylor portion

2:51

of the deltoid ligament attaching

2:53

to this concave border of the talis.

2:57

This is the strongest part

2:59

Of the deltoid ligament.

3:01

As we move slightly forward in the coronal pain in this

3:04

particular person, we can identify a thinner

3:09

deep anterior tibio Taylor portion

3:13

of the deltoid ligament.

3:16

Let's look at an abnormality now involving

3:18

the deltoid ligament.

3:20

This is what abnormality of the deep posterior

3:24

tibial tailor fibers would look like.

3:26

And by the way, when you have that,

3:28

you often will have marrow edema within

3:33

the TAUs to help you diagnose that.

3:36

There's an abnormality there. This is partial tearing.

3:40

And here we can see an addition that there is tearing,

3:43

at least at the attachment here, the proximal attachment

3:47

of the deep anter tibio tailor ligament or fibers.

3:52

We go to our sagittal image

3:55

anulus inter canicular groove posterior kaulu,

3:59

and we can see abnormal fibers attaching everywhere

4:03

to the medial Malala.

4:04

We're dealing with tear tearing involving the deep

4:09

anterior and posterior fibers.