Ankle Syndesmosis
(Redirected from Distal Tibiofibular Joint)
Description
-
![Illustration of the normal tibiofibular syndesmosis[1]](/w/images/thumb/f/fe/Normal_ankle_syndesmosis.jpeg/120px-Normal_ankle_syndesmosis.jpeg)
Illustration of the normal tibiofibular syndesmosis[1] -
![X-ray measurement of the distal tibiofibular syndesmosis. The space labeled “A” is the tibiofibular clear space (distance between posterolateral margin of distal tibia and medial margin of lateral malleolus). The space labeled “B” is the tibiofibular overlap (distance between anterolateral margin of distal tibia and medial margin of lateral malleolus).[2]](/w/images/thumb/2/2b/Ankle_Ankle_Syndesmosis.jpeg/97px-Ankle_Ankle_Syndesmosis.jpeg)
X-ray measurement of the distal tibiofibular syndesmosis. The space labeled “A” is the tibiofibular clear space (distance between posterolateral margin of distal tibia and medial margin of lateral malleolus). The space labeled “B” is the tibiofibular overlap (distance between anterolateral margin of distal tibia and medial margin of lateral malleolus).[2] -
![Taping of a high ankle sprain in a baseball player[3]](/w/images/thumb/6/6f/Ankle_Syndesmosis_clinical.jpeg/120px-Ankle_Syndesmosis_clinical.jpeg)
Taping of a high ankle sprain in a baseball player[3] -
![The ligaments of the tibiofibular syndesmosis include the anterior and posterior tibiofibular ligaments (AIFTL and PIFTL), the interosseous ligament (IOL), and the transverse ligament (TL)[4]](/w/images/thumb/4/4e/Ankle_syndesmosis_anatomy.jpeg/120px-Ankle_syndesmosis_anatomy.jpeg)
The ligaments of the tibiofibular syndesmosis include the anterior and posterior tibiofibular ligaments (AIFTL and PIFTL), the interosseous ligament (IOL), and the transverse ligament (TL)[4] -
![Posterior view of a left foot and ankle in neutral plantar flexion and dorsiflexion diagramming the anatomic sites of attachment and course of the posterior inferior tibiofibular ligament (PITFL). CFL, calcaneofibular ligament; PTFL, posterior talofibular ligament.[5]](/w/images/thumb/d/de/Posterior_distal_tibiofibular_syndesmosis_anatomy.jpeg/120px-Posterior_distal_tibiofibular_syndesmosis_anatomy.jpeg)
Posterior view of a left foot and ankle in neutral plantar flexion and dorsiflexion diagramming the anatomic sites of attachment and course of the posterior inferior tibiofibular ligament (PITFL). CFL, calcaneofibular ligament; PTFL, posterior talofibular ligament.[5]
![Illustration of the normal tibiofibular syndesmosis[1]](/File:Normal_ankle_syndesmosis.jpeg)
![X-ray measurement of the distal tibiofibular syndesmosis. The space labeled “A” is the tibiofibular clear space (distance between posterolateral margin of distal tibia and medial margin of lateral malleolus). The space labeled “B” is the tibiofibular overlap (distance between anterolateral margin of distal tibia and medial margin of lateral malleolus).[2]](/File:Ankle_Ankle_Syndesmosis.jpeg)
![Taping of a high ankle sprain in a baseball player[3]](/File:Ankle_Syndesmosis_clinical.jpeg)
![The ligaments of the tibiofibular syndesmosis include the anterior and posterior tibiofibular ligaments (AIFTL and PIFTL), the interosseous ligament (IOL), and the transverse ligament (TL)[4]](/File:Ankle_syndesmosis_anatomy.jpeg)
![Posterior view of a left foot and ankle in neutral plantar flexion and dorsiflexion diagramming the anatomic sites of attachment and course of the posterior inferior tibiofibular ligament (PITFL). CFL, calcaneofibular ligament; PTFL, posterior talofibular ligament.[5]](/File:Posterior_distal_tibiofibular_syndesmosis_anatomy.jpeg)
Names
- Distal Tibiofibular Syndesmosis
- Inferior Tibiofibular Joint
- Distal Tibiofibular Joint
- Ankle Syndesmosis
General
- Defined as a syndesmotic articulation between distal fibula, distal tibia
- Specifically, the convex surface of the fibula and concave surface of the tibia
- Firmly attached by a series of ligaments[8]
- Stability is critical for normal functioning of the ankle, lower extremity
Anterior Inferior Tibiofibular Ligament
- Flat, strong ligament
- Origin: longitudinal tubercle on the anterior aspect of the lateral malleolus
- Fibers course superior, medially
- Insert: anterolateral tubercle of the tibia
- Increase in length from proximal to distal
- Helps prevent excessive fibular movement, external talar rotation[9]
Posterior Inferior Tibiofibular Ligament
- Superficial fibers
- Origin: posterior tubercle of the tibia
- Run obliquely, distally, laterally
- Insert: posterior lateral malleolus
- Works with anterior inferior tibiofibular ligament to hold fibula close in the fibular groove
- Deep fibers
- Also called the Transverse Tibiofibular Ligament
- Thicken, strong ligament with twisting fibers
- Origin: posterior tibial margin
- Insertion: osteochondral junction on posterior, medial margin of distal fibula
- Helps to prevent posterior tibial talar translation
- Creates a posterior labrum, deepens articular surface of distal tibia
- Fills the posteromedial aspect of the lateral malleolus, deepening mortise, increasing stability
Interosseous Ligament of the Leg
- Origin: anteroinferior triangular aspect of the medial aspect of the distal fibular shaft
- Insert: lateral surface of the distal tibia
- Thickening of the distal Interosseous Membrane of the Leg
- Thought to act as a spring, allowing for slight separation between medial/lateral mal during dorsiflexion[10]
Significance of Each Ligament
- Three major ligaments account for 90% of total resistance to fibular displacement
- Individual contributions[10]
- Anterior inferior tibiofibular ligament (35%)
- Transverse (deep posterior) ligament (33%)
- Interosseous ligament (22%)
- Superficial posterior inferior ligament (9%)
Clinical Significance
See Also
References
- ↑ Liu, Jiayong, Daniel Valentine, and Nabil A. Ebraheim. "Management of syndesmosis injury: a narrative review." Orthopedic Research and Reviews (2022): 471-475.
- ↑ Huang, Qiang, et al. "Diagnosis of tibiofibular syndesmosis instability in Weber type B malleolar fractures." Journal of International Medical Research 48.7 (2020): 0300060520939752.
- ↑ Molinari, A., M. Stolley, and A. Amendola. "High ankle sprains (syndesmotic) in athletes: diagnostic challenges and review of the literature." The Iowa Orthopaedic Journal 29 (2009): 130.
- ↑ Hao, Kevin A., et al. "Intraoperative assessment of reduction of the ankle syndesmosis." Current Reviews in Musculoskeletal Medicine 15.5 (2022): 344-352.
- ↑ Williams, Brady T., et al. "Ankle syndesmosis: a qualitative and quantitative anatomic analysis." The American Journal of Sports Medicine 43.1 (2015): 88-97.
- ↑ 6.0 6.1 Norkus, Susan A., and R. T. Floyd. "The anatomy and mechanisms of syndesmotic ankle sprains." Journal of athletic training 36.1 (2001): 68.
- ↑ Liu, Jiayong, Daniel Valentine, and Nabil A. Ebraheim. "Management of syndesmosis injury: A narrative review." Orthopedic Research and Reviews (2022): 471-475.
- ↑ Vogl TJ, Hochmuth K, Diebold T, et al. Magnetic resonance imaging in the diagnosis of acute injured distal tibiofibular syndesmosis. Invest Radiol. 1997;32:401–409.
- ↑ Sarsam, I. M., and S. P. F. Hughes. "The role of the anterior tibio-fibular ligament in talar rotation: an anatomical study." Injury 19.2 (1988): 62-64.
- ↑ 10.0 10.1 Ogilvie-Harris, D. J., S. C. Reed, and T. P. Hedman. "Disruption of the ankle syndesmosis: biomechanical study of the ligamentous restraints." Arthroscopy: The Journal of Arthroscopic & Related Surgery 10.5 (1994): 558-560.