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The anterior tibiofibular ligament has a constant distal fascicle that contacts the anterolateral part of the talus

  • Ankle
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The anterior tibiofibular ligament (ATiFL) and its distal fascicle have been the subject of numerous studies, mainly due to the involvement of this ligament in anterolateral soft-tissue impingement of the ankle. There is currently no firm evidence related to the incidence of the distal fascicle or the frequency with which it is in contact with the talus, or whether this is a constant anatomic finding. In addition, the terminology used to refer to this structure is not accurate and varies widely in previous studies. The purpose of this study was to perform an anatomic study on a large number of specimens to clarify the anatomy of the anterior tibiofibular ligament, and specifically its distal fascicle, and its possible role in anterior ankle impingement syndrome.

Methods

During a 7-year period (2010–2016), cadaveric ankle specimens dissected at our Anatomy Department were included in this study, accounting for a total of 154 ankles. The incidence of the distal fascicle and its contact with the talus were documented.

Results

One hundred and seventeen ankles were included [78 men, 39 women, with a median age of 79.3 years (range 51–100 years)]. The ATiFL was found to have a distal fascicle in 100% of ankles, contacting the anterolateral part of the talus in all cases. The contact was increased in plantarflexion and reduced in dorsiflexion and finally disappeared completely in maximum dorsiflexion.

Conclusions

The ATiFL has a constant distal fascicle that is in contact with the talus in the neutral position and in plantar flexion. Contact disappears in maximum dorsiflexion.

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References

  1. Bassett FH, Gates HS, Billys JB, Morris HB, Nikolaou PK (1990) Talar impingement by the anteroinferior tibiofibular ligament. A cause of chronic pain in the ankle after inversion sprain. J Bone Jt Surg Am 72:55–59

    Article  Google Scholar 

  2. 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 Sport Traumatol Arthrosc 15:465–471

    Article  Google Scholar 

  3. Nikolopoulos C (1982) Anterolateral instability of the ankle joint: an anatomical, experimental, and clinical study. Ph.D. Thesis, University of Athens

  4. Nikolopoulos CE (2004) The accessory anteroinferior tibiofibular ligament as a cause of talar impingement: a cadaveric study. Am J Sports Med 32:389–395

    Article  Google Scholar 

  5. Subhas N, Vinson EN, Cothran RL, Santangelo JR, Nunley JA, Helms CA (2008) MRI appearance of surgically proven abnormal accessory anterior-inferior tibiofibular ligament (Bassett’s ligament). Skelet Radiol 37:27–33

    Article  Google Scholar 

  6. Yeo ED, Rhyu IJ, Kim HJ, Kim DS, Ahn JH, Lee YK (2016) Can Bassett’s ligament be removed? Knee Surg Sport Traumatol Arthrosc 24(4):1236–1242

    Article  Google Scholar 

  7. Akseki D, Pinar H, Bozkurt M, Yaldiz K, Araç S (1999) The distal fascicle of the anterior inferior tibio-fibular ligament as a cause of anterolateral ankle impingement. Acta Orthop Scand 70:478–482

    Article  CAS  Google Scholar 

  8. Akseki D, Pinar H, Yaldiz K, Akseki NG, Arman C (2002) The anterior inferior tibiofibular ligament and talar impingement: a cadaveric study. KSSTA 10:321–326

    Google Scholar 

  9. Bartoníček J (2003) Anatomy of the tibiofibular syndesmosis and its clinical relevance. Surg Radiol Anat 25:379–386

    Article  Google Scholar 

  10. Boonthathip M, Chen L, Trudell DJ, Resnick DL (2010) Tibiofibular syndesmotic ligaments: MR arthrography in cadavers with anatomic correlation. Radiology 254:827–836

    Article  Google Scholar 

  11. Ebraheim NA, Taser F, Shafiq Q, Yeasting RA (2006) Anatomical evaluation and clinical importance of the tibiofibular syndesmosis ligaments. Surg Radiol Anat 28:142–149

    Article  Google Scholar 

  12. Ray RG, Kriz BM (1991) Anterior inferior tibiofibular ligament. Variations and relationship to the talus. J Am Podiatr Med Assoc 81:479–485

    Article  CAS  Google Scholar 

  13. Hermans JJ, Beumer A, De Jong TAW, Kleinrensink GJ (2010) Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach. J Anat 217:633–645

    Article  Google Scholar 

  14. Jacobson K, Ng A, Haffner KE (2011) Arthroscopic treatment of anterior ankle impingement. Clin Podiatr Med Surg 28:491–510

    Article  Google Scholar 

  15. Dalmau-Pastor M, Vega J (2017) Letter regarding: cadaveric analysis of the distal tibiofibular syndesmosis. Foot Ankle Int 38:343–345

    Article  Google Scholar 

  16. Federative Committee on Anatomical Terminology (1998) International Anatomical Terminology. Thieme, Stuttgart

    Google Scholar 

  17. Golanó P, Vega J, Pérez-Carro L, Götzens V (2006) Ankle anatomy for the arthroscopist. Part II: role of the ankle ligaments in soft tissue impingement. Foot Ankle Clin 11:275–296

    Article  Google Scholar 

  18. Vega J, Dalmau-Pastor M, Malagelada F, Fargues-Polo B, Peña F (2017) Ankle arthroscopy: an update. J Bone Jt Surg 99:1395–1407

    Article  Google Scholar 

  19. Rasmussen O, Tovborg-Jensen IB, Boe S (1982) Distal tibiofibular ligaments. Acta Orthop Scand 53:681–686

    Article  CAS  Google Scholar 

  20. Caputo AM, Lee JY, Spritzer CE, Easley ME, Deorio JK, Ii JAN, Defrate LE, Carolina N (2009) In vivo kinematics of the tibiotalar joint after lateral ankle instability. Am J Sports Med 37:2241–2248

    Article  Google Scholar 

  21. Vega J, Peña F, Golanó P (2016) Minor or occult ankle instability as a cause of anterolateral pain after ankle sprain. Knee Surg Sport Traumatol Arthrosc 24(4):1116–1123

    Article  Google Scholar 

  22. Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E (2004) Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Jt Surg Am 86–A:1909–1916

    Article  Google Scholar 

  23. Lau RL, Perruccio AV, Gandhi R, Mahomed NN (2012) The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature. BMC Musculoskelet Disord 13:250

    Article  Google Scholar 

  24. McAteer JP, LaRiviere CA, Drugas GT, Abdullah F, Oldham KT, Goldin AB (2013) Influence of surgeon experience, hospital volume, and specialty designation on outcomes in pediatric surgery. JAMA Pediatr 167:468–475

    Article  Google Scholar 

  25. Pennington N, Redmond A, Stewart T, Stone M (2014) The impact of surgeon handedness in total hip replacement. Ann R Coll Surg Engl 96:437–441

    Article  CAS  Google Scholar 

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Funding

No funding was provided for this study.

Author information

Authors and Affiliations

  1. Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain

    Miki Dalmau-Pastor, F. Malagelada, M. C. Manzanares & J. Vega

  2. Manresa Health Science School, University of Vic-Central University of Catalonia, Barcelona, Vic, Spain

    Miki Dalmau-Pastor

  3. GRECMIP (Groupe de Recherche et d’Etude en Chirurgie Mini-Invasive du Pied), Mérignac, France

    Miki Dalmau-Pastor & J. Vega

  4. Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK

    F. Malagelada

  5. Department of Orthopedic Surgery, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Amsterdam, The Netherlands

    G. M. M. J. Kerkhoffs

  6. Academic Center for Evidence-based Sports Medicine (ACES), Academic Medical Center, Amsterdam, The Netherlands

    G. M. M. J. Kerkhoffs

  7. Amsterdam Collaboration on Health and Safety in Sports (ACHSS), AMC/VUmc IOC Research Center, Amsterdam, The Netherlands

    G. M. M. J. Kerkhoffs

  8. Department of Orthopaedics, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Göthenburg, Sweden

    J. Karlsson

  9. Foot and Ankle Unit, Hospital Quirón Barcelona, Barcelona, Spain

    J. Vega

Authors
  1. Miki Dalmau-Pastor
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  2. F. Malagelada
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  3. G. M. M. J. Kerkhoffs
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  4. J. Karlsson
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  5. M. C. Manzanares
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  6. J. Vega
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Corresponding author

Correspondence to Miki Dalmau-Pastor.

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Conflict of interest

We declare that we have no conflicts of interest in the authorship or publication of this contribution.

Ethical approval

Ethical approval statement was provided by the University of Barcelona with Institutional Review Board IRB00003099.

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Dalmau-Pastor, M., Malagelada, F., Kerkhoffs, G.M.M.J. et al. The anterior tibiofibular ligament has a constant distal fascicle that contacts the anterolateral part of the talus. Knee Surg Sports Traumatol Arthrosc 28, 48–54 (2020). https://doi.org/10.1007/s00167-018-5123-z

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  • DOI: https://doi.org/10.1007/s00167-018-5123-z

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