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A diagnostic algorithm for acute syndesmotic injuries or ”high ankle sprains”: history, physical findings and imaging

Published in N°010 - March / April 2021
Article viewed 11 times

A diagnostic algorithm for acute syndesmotic injuries or ”high ankle sprains”: history, physical findings and imaging

By S.A. Stufkens in category UPDATE

The syndesmotic ligamentous complex plays an important role in the stability of the talocrural joint. Understanding the anatomy of the structures is mandatory for interpretation of clinical symptoms, radiographs, CT, MRI and ankle arthroscopy.

Introduction

The syndesmotic ligamentous complex plays an important role in the stability of the talocrural joint. Understanding the anatomy of the structures is mandatory for interpretation of clinical symptoms, radiographs, CT, MRI and ankle arthroscopy. [1]

The distal tibiofibular syndesmosis includes four main structures. The anterior-inferior tibiofibular ligament (AiTFL) connects the anterolateral tubercle of the distal tibia to the anterior tubercle of the distal fibula. An accessory anterior-inferior tibiofibular ligament, also called Bassett’s ligament, is described in the literature.[2] (Figure 1) The posterior-inferior tibiofibular ligament (PiTFL) connects the posterior tubercle of the distal tibia to the posterior part of the distal fibula. The interosseous ligament (IOL) is a distal thickened continuation of the interosseous membrane.

Figure 1: Ankle joint with AiTFL
1- AiTFL, the distal fascicle is also known as Bassett’s ligament; 
2- footprint of AiTFL on the tibia

 

The interosseous ligament (IOL) lies 0.5 to 2 cm above the joint line. The area underneath the interosseous ligament is generally filled with the synovial plica from the tibiotalar joint. [3, 4] The inferior transverse ligament (ITL) forms the most distal aspect of the tibiotalar articulation and...

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