Skip to main content
SpringerLink
Log in

High ankle sprain: sonographic demonstration of a posterior inferior tibiofibular ligament avulsion

  • Case Report
  • Published:
Journal of Ultrasound Aims and scope Submit manuscript

Abstract

Syndesmotic injuries, also referred as high ankle sprains, may cause significant ankle instability and chronic pain. Ultrasound (US) is a well-proven imaging modality to evaluate the ligaments of the ankle, due to its high spatial resolution and the possibility to perform dynamic examinations. However, considering the syndesmosis complex, the sonographic appearance of the posterior inferior tibiofibular ligament (PITFL) is not well described in the pertinent literature and, to the best of our knowledge, we found no report of PITFL avulsion demonstrated at US, as in the case presented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Hunt KJ (2013) Syndesmosis injuries. Curr Rev Musculoskelet Med 6(4):304–312. https://doi.org/10.1007/s12178-013-9184-9

    Article  PubMed  PubMed Central  Google Scholar 

  2. Martinoli C, Ankle BS (2016) Ultrasound of the musculoskeletal system. Springer, Berlin, pp 773–834. https://doi.org/10.1007/978-3-540-28163-4_16

    Book  Google Scholar 

  3. De Maeseneer M, Marcelis S, Jager T et al (2009) Sonography of the normal ankle: a target approach using skeletal reference points. Am J Roentgenol 192(2):487–495. https://doi.org/10.2214/AJR.08.1316

    Article  Google Scholar 

  4. Sconfienza LM, Orlandi D, Lacelli F, Serafini G, Silvestri E (2015) Dynamic high-resolution us of ankle and midfoot ligaments: normal anatomic structure and imaging technique. Radiographics 35(1):164–178. https://doi.org/10.1148/rg.351130139

    Article  PubMed  Google Scholar 

  5. Döring S, Provyn S, Marcelis S et al (2018) Ankle and midfoot ligaments: ultrasound with anatomical correlation: a review. Eur J Radiol 107:216–226. https://doi.org/10.1016/j.ejrad.2018.08.011

    Article  PubMed  Google Scholar 

  6. Stella SM, Ciampi B, Del Chiaro A et al (2020) Sonographic visibility of the main posterior ankle ligaments and para-ligamentous structures in 15 healthy subjects. J Ultrasound. https://doi.org/10.1007/s40477-019-00420-2

    Article  PubMed  Google Scholar 

  7. Bianchi S, Becciolini M (2019) Ultrasound features of ankle retinacula: normal appearance and pathologic findings. J Ultrasound Med 38(12):3321–3334. https://doi.org/10.1002/jum.15026

    Article  PubMed  Google Scholar 

  8. Golanó P, Vega J, de Leeuw PAJ et al (2010) Anatomy of the ankle ligaments: a pictorial essay. Knee Surgery, Sport Traumatol Arthrosc 18(5):557–569. https://doi.org/10.1007/s00167-010-1100-x

    Article  Google Scholar 

  9. Lin CF, Gross MT, Weinhold P (2006) Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. J Orthop Sports Phys Ther 36(6):372–384. https://doi.org/10.2519/jospt.2006.2195

    Article  PubMed  Google Scholar 

  10. 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(6):633–645. https://doi.org/10.1111/j.1469-7580.2010.01302.x

    Article  PubMed  PubMed Central  Google Scholar 

  11. Peetrons P, Creteur V, Bacq C (2004) Sonography of ankle ligaments. J Clin Ultrasound 32:491–499. https://doi.org/10.1002/jcu.20068

    Article  PubMed  Google Scholar 

  12. Draghi F, Gregoli B, Bortolotto C (2014) Absence of elevation of fibular tendons during dorsal hyperflexion of the foot: a sign of loss of the calcaneofibular ligament. J Ultrasound Med 33(7):1307–1308. https://doi.org/10.7863/ultra.33.7.1307

    Article  PubMed  Google Scholar 

  13. Durkee NJ, Jacobson JA, Jamadar DA, Femino JE, Karunakar MA, Hayes CW (2003) Sonographic evaluation of lower extremity interosseous membrane injuries: retrospective review in 3 patients. J Ultrasound Med 22(12):1369–1375. https://doi.org/10.7863/jum.2003.22.12.1369

    Article  PubMed  Google Scholar 

  14. Hoffman DF, Adams E, Bianchi S (2015) Ultrasonography of fractures in sports medicine. Br J Sports Med 49(3):152–160. https://doi.org/10.1136/bjsports-2014-094217

    Article  PubMed  Google Scholar 

  15. Neumaier Probst E, Maas R, Meenen NM (1997) Isolated fracture of the posterolateral tibial lip (Volkmann’s triangle). Acta radiol 38(3):359–362. https://doi.org/10.3109/02841859709172083

    Article  CAS  PubMed  Google Scholar 

  16. Becciolini M, Galletti S, Vallone G, Stella SM, Ricci V (2020) Sonographic diagnosis of clinically unsuspected thrombosis of the medial marginal vein and dorsal arch of the foot. J Ultrasound. https://doi.org/10.1007/s40477-019-00421-1

    Article  PubMed  Google Scholar 

  17. Brown KW, Morrison WB, Schweitzer ME, Parellada JA, Nothnagel H (2004) MRI findings associated with distal tibiofibular syndesmosis injury. Am J Roentgenol 182(1):131–136. https://doi.org/10.2214/ajr.182.1.1820131

    Article  Google Scholar 

Download references

Funding

No funding was received.

Author information

Authors and Affiliations

  1. Misericordia Di Pistoia, Via Bonellina 1, 51100, Pistoia, Italy

    Marco Becciolini & Giovanni Bonacchi

  2. Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Pisa, Italy

    Marco Becciolini, Giovanni Bonacchi & Salvatore Massimo Stella

  3. Musculoskeletal Ultrasound School, Italian Society for Ultrasound in Medicine and Biology (SIUMB), Bologna, Italy

    Stefano Galletti & Vincenzo Ricci

  4. Department of Biomedical and Neuromotor Science, Physical and Rehabilitation Medicine Unit, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy

    Vincenzo Ricci

Authors
  1. Marco Becciolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni Bonacchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Salvatore Massimo Stella
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefano Galletti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vincenzo Ricci
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco Becciolini.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Becciolini, M., Bonacchi, G., Stella, S.M. et al. High ankle sprain: sonographic demonstration of a posterior inferior tibiofibular ligament avulsion. J Ultrasound 23, 431–433 (2020). https://doi.org/10.1007/s40477-020-00455-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40477-020-00455-w

Keywords

Search

Navigation