Advertisement

Anatomy of the ankle ligaments: a pictorial essay

  • Pau GolanóEmail author
  • Jordi Vega
  • Peter A. J. de Leeuw
  • Francesc Malagelada
  • M. Cristina Manzanares
  • Víctor Götzens
  • C. Niek van Dijk
Ankle

Abstract

Understanding the anatomy of the ankle ligaments is important for correct diagnosis and treatment. Ankle ligament injury is the most frequent cause of acute ankle pain. Chronic ankle pain often finds its cause in laxity of one of the ankle ligaments. In this pictorial essay, the ligaments around the ankle are grouped, depending on their anatomic orientation, and each of the ankle ligaments is discussed in detail.

Keywords

Ankle anatomy Lateral collateral ligament Medial collateral ligament Ankle impingement Ankle sprain 

Notes

Acknowledgments

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this review. No sources of funding were received to assist in this review. The authors have no conflicts of interest that are directly relevant to this review.

References

  1. 1.
    Akseki D, Pinar H, Bozkurt M et al (1999) The distal fascicle of the anterior inferior tibiofibular ligament as a cause of anterolateral ankle impingement. Results of arthroscopic resection. Acta Orthop Scand 70:478–482CrossRefPubMedGoogle Scholar
  2. 2.
    Akseki D, Pinar H, Yaldiz K et al (2002) The anterior inferior tibiofibular ligament and talar impingement: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 10:321–326CrossRefPubMedGoogle Scholar
  3. 3.
    Anderson KJ, Lecoq JF (1954) Operative treatment of injury to the fibular collateral ligament of the ankle. J Bone Joint Surg Am 36:825–832PubMedGoogle Scholar
  4. 4.
    Balduini FC, Tetzlaff J (1982) Historical perspectives on injuries of the ligaments of the ankle. Clin Sports Med 1:3–12PubMedGoogle Scholar
  5. 5.
    Bartonícek J (2003) Anatomy of the tibiofibular syndesmosis and its clinical relevance. Surg Radiol Anat 25:379–386CrossRefPubMedGoogle Scholar
  6. 6.
    Bassett FH III, Gates HS III, Billys JB et al (1990) Talar impingement by the anteroinferior tibiofibular ligament. A cause of chronic pain in the ankle after inversion sprain. J Bone Joint Surg Am 72:55–59PubMedGoogle Scholar
  7. 7.
    Boruta PM, Bishop JO, Braly WG et al (1990) Acute ankle ligament injuries; a literature review. Foot Ankle 11:107–113CrossRefPubMedGoogle Scholar
  8. 8.
    Boss AP, Hintermann B (2002) Anatomical study of the medial ankle ligament complex. Foot Ankle Int 23:547–553PubMedGoogle Scholar
  9. 9.
    Broström L (1966) Sprained ankles V. Treatment and prognosis in recent ligament ruptures. Acta Chir Scand 132:537–550PubMedGoogle Scholar
  10. 10.
    Burks RT, Morgan J (1994) Anatomy of the lateral ankle ligaments. Am J Sport Med 22:72–77CrossRefGoogle Scholar
  11. 11.
    Clanton TO, Paul P (2002) Syndesmosis injuries in athletes. Foot Ankle Clin N Am 7:529–549CrossRefGoogle Scholar
  12. 12.
    Delfaut EM, Demondion X, Boutry N et al (2003) Multi-fasciculated anterior talo-fibular ligament: reassessment of normal findings. Eur Radiol 13:1836–1842CrossRefPubMedGoogle Scholar
  13. 13.
    Ebraheim NA, Taser F, Shafiq Q et al (2006) Anatomical evaluation and clinical importance of the tibiofibular syndesmosis ligaments. Surg Radiol Anat 28:142–149CrossRefPubMedGoogle Scholar
  14. 14.
    Ferkel RD (1994) Differential diagnosis of the chronic ankle sprain pain in the athlete. Sports Med Arthroscopy Rev 2:274–283Google Scholar
  15. 15.
    Gerber JP, Williams GN, Scoville CR et al (1998) Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int 19:653–660CrossRefPubMedGoogle Scholar
  16. 16.
    Golanó P, Mariani PP, Rodríguez-Niedenfuhr M et al (2002) Arthroscopic anatomy of the posterior ankle ligaments. Arthroscopy 18:353–358CrossRefPubMedGoogle Scholar
  17. 17.
    Hamilton WG, Gepper MJ, Thompson FM (1996) Pain in the posterior aspect of the ankle in dancers. Differential diagnosis and operative treatment. J Bone Joint Surg Am 78:1491–1500PubMedGoogle Scholar
  18. 18.
    Hoefnagels EM, Waites MD, Wing ID et al (2007) Biomechanical comparison of the interosseous tibiofibular ligament and the anterior tibiofibular ligament. Foot Ankle Int 28:602–604CrossRefPubMedGoogle Scholar
  19. 19.
    Horner G, Liu S (1996) Arthroscopic treatment of talar impingement by the accessory anteroinferior tibiofibular ligament. Arthroscopy 12:384Google Scholar
  20. 20.
    Johnson EE, Markolf KL (1983) The contribution of the anterior talofibular ligament to ankle laxity. J Bone Joint Surg Am 65:81–88PubMedGoogle Scholar
  21. 21.
    Kapanji IA (1982) Cuadernos de fisiología articular (Joint physiology). Cuaderno III. Barcelona:Masson, SA, pp 174–177Google Scholar
  22. 22.
    Liu SH, Raskin A, Osti L et al (1994) Arthroscopic treatment of anterolateral ankle impingement. Arthroscopy 10:215–218CrossRefPubMedGoogle Scholar
  23. 23.
    Milner CE, Soames RW (1997) Anatomical variations of the anterior talofibular ligament of the human ankle joint. J Anat 191:457–458CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Milner CE, Soames RW (1998) Anatomy of the collateral ligaments of the human ankle joint. Foot Ankle Int 19:757–760CrossRefPubMedGoogle Scholar
  25. 25.
    Nikolopoulos CE (1982) Anterolateral instability of the ankle joint. An anatomical, experimental and clinical study. Thesis, University of Athenes, Athenes, GreeceGoogle Scholar
  26. 26.
    Nikolopoulus CE, Tsirikos AI, Sourmelis S et al (2004) The accessory anteroinferior tibiofibular ligament as a cause of talar impingement. A cadaveric study. J Sports Med 32:389–395CrossRefGoogle Scholar
  27. 27.
    Oh CS, Won HS, Chung IH et al (2006) Anatomic variations and MRI of intermalleolar ligament. AJR 186:943–947CrossRefPubMedGoogle Scholar
  28. 28.
    Pankovich AM, Shivaram MS (1979) Anatomical basis of variability in injuries of the medial malleolus and the deltoid ligament. I. Anatomical studies. Acta Orthop Scand 50:217–223CrossRefPubMedGoogle Scholar
  29. 29.
    Paturet G (1951) Traité d’anatomie humaine (A treatise on human anatomy). París:Masson, pp 704–711Google Scholar
  30. 30.
    Peace KAL, Hillier JC, Hulme A et al (2004) MRI features of posterior ankle impingement syndrome in ballet dances: a review of 25 cases. Clin Radiol 59:1025–1033CrossRefPubMedGoogle Scholar
  31. 31.
    Rasmussen O, Tovborg-Jensen I, Boe S (1982) Distal tibiofibular ligaments, analysis of function. Acta Orthop Scand 53:681–686CrossRefPubMedGoogle Scholar
  32. 32.
    Ray RG, Kriz BM (1991) Anterior inferior tibiofibular ligament. Variations and relationship to the talus. J Am Podiatr Med Assoc 81:479–485CrossRefPubMedGoogle Scholar
  33. 33.
    Renstrom FH, Lynch SA (1999) Acute injuries of the ankle. Foot Ankle Clin 4:697–711Google Scholar
  34. 34.
    Rosenberg ZS, Cheung YY, Beltran J et al (1995) Posterior intermalleolar ligament of the ankle: normal anatomy and MR imaging features. AJR 165:387–390CrossRefPubMedGoogle Scholar
  35. 35.
    Ruth CJ (1961) The surgical treatment of injuries of the fibular collateral ligaments of the ankle. J Bone Joint Surg Am 43:233–236Google Scholar
  36. 36.
    Sarrafian SK (1993) Anatomy of the foot and ankle. Descriptive, topographic, functional, 2nd edn. Lippincott, Philadelphia, pp 159–217Google Scholar
  37. 37.
    Taylor DC, Englehardt DL, Bassett FH (1992) Syndesmosis sprains of the ankle. The influence of heterotopic ossification. Am J Sport Med 20:146–150CrossRefGoogle Scholar
  38. 38.
    Testut L, Latarjet A (1985) Tratado de anatomía humana (A treatise on human anatomy). Barcelona:Salvat Editores, SA, pp 704–719Google Scholar
  39. 39.
    Trouilloud P, Dia A, Grammont P et al (1988) Variations du ligament calcaneo-fibulaire. Aplications à la cinématique de la cheville (Variations in the calcaneofibular ligament. Applications to ankle kinetics). Bull Assoc Anat 72:31–35Google Scholar
  40. 40.
    van den Bekerom MPJ, Oostra RJ, Golanó P et al (2008) The anatomy in relation to injury of the lateral collateral ligaments of the ankle: a current concepts review. Clin Anat 21:619–626CrossRefPubMedGoogle Scholar
  41. 41.
    van den Bekerom MPJ, Raven EEJ (2007) The distal fascicle of the anterior inferior tibiofibular ligament as a cause of tibiotalar impingement syndrome: a current concepts review. Knee Surg Sports Traumatol Arthosc 15:465–471CrossRefGoogle Scholar
  42. 42.
    Verhagen RA, de Keizer G, van Dijk CN (1995) Long-term follow-up of inversion trauma of the ankle. Arch Orthop Trauma Surg 114:92–96CrossRefPubMedGoogle Scholar
  43. 43.
    van Dijk CN (1994) On diagnostic strategies in patient with severe ankle sprain. Thesis, University of Amsterdam, The NetherlandsGoogle Scholar
  44. 44.
    van Dijk CN, Scholten PE, Krips R (2000) A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Technical note. Arthroscopy 16:871–876CrossRefPubMedGoogle Scholar
  45. 45.
    van Dijk CN, de Leeuw PA, Scholten PE (2009) Hindfoot endoscopy for posterior ankle impingement. Surgical technique. J Bone Joint Surg Am 2:287–298Google Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • Pau Golanó
    • 1
    Email author
  • Jordi Vega
    • 3
  • Peter A. J. de Leeuw
    • 4
  • Francesc Malagelada
    • 5
  • M. Cristina Manzanares
    • 2
  • Víctor Götzens
    • 2
  • C. Niek van Dijk
    • 4
  1. 1.Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics (Human Anatomy Unit)University of BarcelonaL’Hospitalet de Llobregat, BarcelonaSpain
  2. 2.Department of Pathology and Experimental Therapeutics (Human Anatomy Unit)University of BarcelonaL’Hospitalet de Llobregat, BarcelonaSpain
  3. 3.Department of Orthopedic and Trauma SurgeryHospital Asepeyo San CugatSan Cugat del Vallès, BarcelonaSpain
  4. 4.Department of Orthopaedic Surgery, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  5. 5.Department of Orthopedic and Trauma SurgeryHospital de MataróMataró, BarcelonaSpain

Personalised recommendations