Anatomy of the ankle ligaments: a pictorial essay

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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.

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Persistent disability associated with ankle sprains: a prospective examination of an athletic population.

Charles Scoville, D. Taylor, Jason G. Williams … (1998)

The purpose of this study was to examine a young athletic population to update the data regarding epidemiology and disability associated with ankle injuries. At the United States Military Academy, all cadets presenting with ankle injuries during a 2-month period were included in this prospective observational study. The initial evaluation included an extensive questionnaire, physical examination, and radiographs. Ankle sprain treatment included a supervised rehabilitation program. Subjects were reevaluated at 6 weeks and 6 months with subjective assessment, physical examination, and functional testing. The mean age for all subjects was 20 years (range, 17-24 years). There were 104 ankle injuries accounting for 23% of all injuries seen. There were 96 sprains, 7 fractures, and 1 contusion. Of the 96 sprains, 4 were predominately medial injuries, 76 were lateral, and 16 were syndesmosis sprains. Ninety-five percent had returned to sports activities by 6 weeks; however, 55% of these subjects reported loss of function or presence of intermittent pain, and 23% had a decrement of >20% in the lateral hop test when compared with the uninjured side. At 6 months, all subjects had returned to full activity; however, 40% reported residual symptoms and 2.5% had a decrement of >20% on the lateral hop test. Neither previous injury nor ligament laxity was predictive of chronic symptomatology. Furthermore, chronic dysfunction could not be predicted by the grade of sprain (grade I vs. II). The factor most predictive of residual symptoms was a syndesmosis sprain, regardless of grade. Syndesmosis sprains were most prevalent in collision sports. This study demonstrates that even though our knowledge and understanding of ankle sprains and rehabilitation of these injuries have progressed in the last 20 years, chronic ankle dysfunction continues to be a prevalent problem. The early return to sports occurs after almost every ankle sprain; however, dysfunction persists in 40% of patients for as long as 6 months after injury. Syndesmosis sprains are more common than previously thought, and this confirms that syndesmosis sprains are associated with prolonged disability.

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A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology.

Nguyen Thuan, Rob Scholten, R Krips (2000)

We describe a 2-portal endoscopic approach of the hindfoot with the patient in the prone position. By means of this approach, it is possible to visualize and treat a variety of posterior ankle problems. Not only can pathology of the posterior ankle joint and subtalar joint be visualized and treated, but also periarticular pathology, such as calcifications or scar tissue, can be diagnosed and treated. We describe a professional ballet dancer with chronic flexor hallucis longus tendinitis and a posterior ankle impingement syndrome caused by an os trigonum of both ankles. The patient was successfully treated by removing the os trigonum and releasing the flexor hallucis longus tendon. She resumed her professional activities within 2 months after endoscopic treatment.

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Anatomy of the tibiofibular syndesmosis and its clinical relevance.

Jan Bartonícek (2015)

The purpose of the present study was to describe the anatomical structure of the tibiofibular syndesmosis. Dissection of the tibiofibular syndesmosis was performed on 30 cadaveric specimens of the ankle in adults. The stability of the tibiofibular mortise is ensured by three ligaments. The interosseous tibiofibular ligament forms a spatial network of fibers of a pyramidal shape filled with fibrofatty tissue. The anterior tibiofibular ligament consists of three parts: the upper one is the shortest, the medial one is the strongest and the lower part is the longest and the thinnest. The posterior tibiofibular ligament is a strong, compact ligament the lower margin of which literally forms the articular labrum for the lateral ridge of the trochlea of the talus. The so-called inferior transverse tibiofibular ligament, as this part of the ligament is sometimes characterized, cannot be considered as a separate ligament. Direct contact between the distal tibia and the fibula was found in 23 cases. Contact facets which were covered with articular cartilage were very small and located in the anterior half of the tibiofibular contact line. In the posterior part of the tibiofibular contact line a vertical V-shaped synovial plica attached by its lateral aspect to the fibula dipped between the two bones. In seven cases where there was no direct contact between the two bones this plica extended anteriorly to the anterior tibiofibular ligament. The findings show that in three quarters of cases the connection of the distal tibia and fibula is not a mere syndesmosis but also a synovial joint. The presented facts change traditional opinions on the structure of the tibiofibular syndesmosis and they should be reflected in the treatment of dislocation-fractures of the ankle as well as in case of so-called anterolateral ankle impingement.

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Author and article information

Journal

Title: Knee Surgery, Sports Traumatology, Arthroscopy

Abbreviated Title: Knee Surg Sports Traumatol Arthrosc

Publisher: Springer Nature

ISSN (Print): 0942-2056

ISSN (Electronic): 1433-7347

Publication date Created: April 2016

Publication date (Electronic): April 1 2016

Publication date (Print): April 2016

Volume: 24

Issue: 4

Pages: 944-956

Article

DOI: 10.1007/s00167-016-4059-4

PubMed ID: 27052302

SO-VID: 81481328-e46e-41de-b589-8051f4e48f94

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http://www.springer.com/tdm

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Anatomy of the ankle ligaments: a pictorial essay

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European Investment Bank Publications

Most cited references 30

Persistent disability associated with ankle sprains: a prospective examination of an athletic population.

A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology.

Anatomy of the tibiofibular syndesmosis and its clinical relevance.

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