Abstract
The aim of this study was to describe the detailed anatomical arrangement of ligaments of the tibiofibular syndesmosis and to highlight the clinical aspects of fracture dislocations. This study was performed on 42 legs of adult human embalmed cadavers. Tibiofibular syndesmosis ligaments attachments and their mutual relationships were described and their dimensions were measured. The anterior tibiofibular ligament is usually composed of three parts. This ligament runs obliquely at laterodistaly direction making 35° angle with horizontal plane and posteriorly 65° angle with sagittal plane. The posterior tibiofibular ligament runs almost horizontally 20° angle with horizontal plane. The mean thicknesses of tibial and fibular attachments are 6.38±1.91 mm and 9.67±1.74 mm, respectively. The inferior transverse ligament originates from just below the posterior tibiofibular ligament, which has variations on the shape and dimensions due to its attachment points. The average length is 36.60±9.51 mm. The network between the fibular notch and the distal fibula has been filled with the interosseous tibiofibular ligament whose fibers follow the laterodistal and anterior direction from the tibia to the fibula. It lies proximally 30–40 mm from the mortise. At the inferior view of the tibiofibular syndesmosis a pyramidal shaped cartilaginous facet was observed which was attached to the fibula. The length of this cartilage was variable. Some of synovial plicas from the ankle joints synovial membrane were observed at this view. We conclude that the results of this study may be useful to both orthopedic surgeons and radiologists for anatomic evaluation of the tibiofibular syndesmosis area.
Similar content being viewed by others
References
Akseki D, Pinar H, Yaldiz K et al (2002) The anterior inferior tibiofibular ligament and talar impingement: A cadaveric study. Knee Surg Sports Tr Ar 10:321–326
Balduini FC, Tetzlaff J (1983) Historical perspectives on injuries of the ligaments of the ankle. Clin Sports Med 1220(1):3–12
Bartonicek J (2003) Anatomy of the tibiofibular syndesmosis and its clinical relevance. Surg Radiol Anat 25:379–386
Boytim MJ, Fischer DA, Neumann L (1991) Syndesmotic ankle sprains. Am J Sports Med 19(3):294–298
Bozic KJ, Jaramillo D, DiCanzio J et al (1999) Radiographic appearance of the normal distal tibiofibular syndesmosis in children. J Pediatr Orthop 19(1):14–21
Doskocil M (1988) The distal connection of the tibia and fibula is not just a syndesmosis. Sb Lek 90(1):1–7
Ebraheim NA, Elgafy H, Panadilam T (2003) Syndesmotic disruption in low fibular fractures associated with deltoid ligament injury. Clin Orthop Related Res 409:260–267
Ebraheim NA, Lu J, Yang H et al (1998) The fibular incisure of the tibia on CT scan: a cadaver study. Foot ankle 19(5):318–321
Edwards GS Jr, DeLee JC (1984) Ankle diastasis without fracture. Foot Ankle 4(6):305–312
Fick R (1904) Hanbuch de Anatomie und Mechanik der Gelenke unter berucksichtigung der bewegenden Muskeln. Part 1: Anatomie der Gelenke. Fischer, Jena, pp 440–421
Garrick JG (1982) Epidemiologic perspective. Clin Sports Med 1(1):13–8
Harper MC (1983) An anatomic study of the short oblique fracture of the distal fibula and ankle stability. Foot Ankle 4(1):23–29
Harper MC, Keller TS (1989) A radiographic evaluation of the tibiofibular syndesmosis. Foot Ankle 10(3):156–160
Hopkinson WJ, St Pierre P, Ryan JB et al (1990) Syndesmosis sprains of the ankle. Foot Ankle 10(6):325–330
Johnston TB, Davis DV, Davis F (eds) (1958) Gray’s anatomy, 32nd edn. Longmans Green, London, pp 530–536
Kelikian H, Kelikian AS (1952) Disorders of the ankle. Saunders, Philadelphia, pp 1–91
Kos J (1957) CevnT zasobenT pouzdra hlezenneho kloubu. (Blood supply of the articular capsule of the ankle.). Cs Morf 5:80–93
Leeds HC, Ehrlich MG (1984) Instability of the distal tibiofibular syndesmosis after bimalleolar and trimalleolar ankle fractures. J Bone Joint Surg 66-A(4):490–503
Lidtke RH, George J (2004) Anatomy, biomechanics, and surgical approach to synovial folds within the joints of the foot. J Am Podiatr Med Assoc 94(6):519–527
Liu SH, Nguyen TM (1999) Ankle sprains and other soft tissue injuries. Curr Opin Rheumatol 11(2):132–137
Lutz W (1942) Zur Struktur der unteren Tibiofibularverbindung und der membrane interossea cruris. Anat Entwickl Gesch 111:315–321
Monk CJE (1969) Injuries of the tibiofibular ligaments. J Bone Joint Surg 51B:330–337
Oae K, Takao M, Naito K et al (2003) Injury of the tibiofibular syndesmosis: Value of MR imaging for diagnosis. Radiology 227:155–161
Pankovich AM (1978) Fractures of the fibula proximal to the distal tibiofibular syndesmosis. J Bone and Joint Surg 60-A(2):221–229
Pankovich AM (1979) Fractures of the fibula at the distal tibiofibular syndesmosis. Clin Orthop Relat Res 143:138–147
Ramsey PL, Hamilton W (1976) Changes in tibiotalar area of contact caused by lateral talar shift. J Bone Joint Surg 58A:356–357
Renstrom PAFH, Kannus P (1994) Injuries to the foot and ankle. Orthop Sports Med pp 1705–1767
Rockwood CA, Green DP, Bucholz RW et al (1976) Fractures in Adults. Fourth Edition, vol 2. Lippincott & Raven 1976 Chapter 31 pp 2206
Romanes GJ (1972) Cunningham’s textbook of anatomy, 11th edn. Oxford University Press, London, pp 247–249
Sabacinski KA, Walter JH, Saffo G (1990) Anatomical and histologic investigation of the syndesmotic area in the ankle joint. J Am Pod Med Assoc 80(4):204–210
Sarrafian S (1983) Anatomy of the foot and ankle. Lippincott, Philadelphia
Schneck CD, Mesgarzadeh M, Bonakdarpour A et al (1992) MR imaging of the most commonly injured ankle ligaments I. Normal anatomy. Radiology 184:499–506
Scurran BL (1990) Foot and Ankle Trauma. Chapter 28, Ankle Fractures by Gumann G. Churchill Livingstone, New York, pp 579–625
Snedden MH, Shea JP (2001) Diastasis with low distal fibula fractures: An anatomic rationale. Clin Orthop Relat Res 382:197–205
Sora MC, Strobl B, Staykov D et al (2004) Evaluation of the ankle syndesmosis: A plastination slices study. Clin Anat 17:518–517
Standring S, Editor; Gray’s Anatomy (2005) Williams A, Davies MS. Chapter 115, Ankle and Foot. 39th edn. Churchill Livingstone, London, pp 1525
Stoller DW (1998) MRI, arthroscopy, and surgical anatomy of the joints. Raven Publishers, New York
Taylor DC, Englehardt DL, Bassett FH 3rd (1992) Syndesmosis sprains of the ankle. The influence of heterotopic ossification. Am J Sports Med 20(2):146–150
Yablon IG, Heller FG, Shouse L (1973) The key role of the lateral malleolus in displaced fractures of the ankle. J Bone Joint Surg 59A:165
Yablon IG, Segal D, Leach RE (1983) Ankle injuries. Churchill Livingstone, New York
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ebraheim, N.A., Taser, F., Shafiq, Q. et al. Anatomical evaluation and clinical importance of the tibiofibular syndesmosis ligaments. Surg Radiol Anat 28, 142–149 (2006). https://doi.org/10.1007/s00276-006-0077-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-006-0077-0