Distal Tibiofibular Syndesmosis: Difference between revisions
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The distal tibiofibular syndesmosis is a syndesmotic joint. It is formed between the distal tibia and fibula and it is attached by the interosseous ligament (IOL) | The distal tibiofibular syndesmosis is a syndesmotic joint. It is formed between the distal tibia and fibula and it is attached by the interosseous ligament (IOL) | ||
and 3 major ligaments: the anterior-inferior tibiofibular ligament (ATIFL), the posterior-inferior tibiofibular ligament (PTIFL) and the transverse tibio-fibular ligament (TTFL). <ref name="Hermans" /><ref name="Lin">Lin CF, Gross MT, Weinhold P. Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. Journal of Orthopaedic &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Sports Physical Therapy. 2006 Jun;36(6):372-84.</ref> | and 3 major ligaments: the anterior-inferior tibiofibular ligament (ATIFL), the posterior-inferior tibiofibular ligament (PTIFL) and the transverse tibio-fibular ligament (TTFL). <ref name="Hermans" /><ref name="Lin">Lin CF, Gross MT, Weinhold P. Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. Journal of Orthopaedic &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Sports Physical Therapy. 2006 Jun;36(6):372-84.</ref> | ||
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=== [[Image:Syndesmosis ligaments.jpg|right|5px]]Articulating Surfaces === | === [[Image:Syndesmosis ligaments.jpg|right|5px]]Articulating Surfaces === | ||
*Distal fibula (rough medial convex surface) | |||
*Distal tibia (the triangular notch of the lateral surface) | |||
This forms a mortise for the trochlea of the | |||
=== Ligaments & Joint Capsule<br> === | === Ligaments & Joint Capsule<br> === | ||
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=== Motions Available === | === Motions Available === | ||
The syndesmosis ligament complex function: | |||
*maintains the integrity between the distal tibia and fibula | |||
*resist forces (axial, rotational and translational) that attempt to seperate the two bones | |||
<br> | <br> | ||
{| width="200" border="1" align="center" cellpadding="1" cellspacing="1" | {| width="200" border="1" align="center" cellpadding="1" cellspacing="1" | ||
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| '''ROLE / FUNCTION''' | | '''ROLE / FUNCTION''' | ||
|- | |- | ||
| Distal anterior tibiofibular ligament (ATIFL)< | | Distal anterior tibiofibular ligament (ATIFL)<ref name="Ebraheim">Ebraheim NA, Taser F, Shafiq Q, Yeasting RA. Anatomical evaluation and clinical importance of the tibiofibular syndesmosis ligaments. Surgical and Radiologic Anatomy. 2006 May 1;28(2):142-9.</ref><br> | ||
| | | | ||
Trapezoid shape (the tibial insertion is wider). | |||
The ligament runs obliquely. | |||
| Anterior tubercle of the distal tibia | |||
| Anterior surface of the distal fibula at the lateral malleolus | |||
| | | | ||
|- | |||
| Posterior or posterior-inferior tibiofibular ligament (PTIFL)<ref name="Golano" /> | |||
| | | | ||
Strong compact ligament. | |||
Known as the Superficial component of the PTIFL. | |||
| | | | ||
Posterior edge of the lateral malleolus | Posterior edge of the lateral malleolus | ||
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| | | | ||
|- | |- | ||
| Transverse ligament | | | ||
| Also known as the Deep component of the PTIFL. | Transverse ligament or the Transverse tibio-fibular ligament | ||
(TTFL)<ref name="Golano">Golanó P, Vega J, De Leeuw PA, Malagelada F, Manzanares MC, Götzens V, Van Dijk CN. Anatomy of the ankle ligaments: a pictorial essay. Knee Surgery, Sports Traumatology, Arthroscopy. 2010 May 1;18(5):557-69.</ref> | |||
| | |||
Cone shaped.<br> | |||
Also known as the Deep component of the PTIFL. | |||
<br> | |||
| Proximal area of the malleolar fossa | | Proximal area of the malleolar fossa | ||
| Posterior edge of the tibia -- directly posterior to the cartilaginous covering of the inferior tibial articular surface and may extent up to the medial malleolus. | | Posterior edge of the tibia -- directly posterior to the cartilaginous covering of the inferior tibial articular surface and may extent up to the medial malleolus. | ||
| | | Forms a true labrum. <br>Provides talocrural joint stability. <br>Prevents Posterior translation <br> | ||
|- | |- | ||
| 4 | | 4 | ||
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Description[edit | edit source]
A syndesmosis is a fibrous joint between two bones and linked by ligaments and a strong membrane. [1]
The distal tibiofibular syndesmosis is a syndesmotic joint. It is formed between the distal tibia and fibula and it is attached by the interosseous ligament (IOL)
and 3 major ligaments: the anterior-inferior tibiofibular ligament (ATIFL), the posterior-inferior tibiofibular ligament (PTIFL) and the transverse tibio-fibular ligament (TTFL). [1][2]
Anatomy[edit | edit source]
Articulating Surfaces[edit | edit source]
- Distal fibula (rough medial convex surface)
- Distal tibia (the triangular notch of the lateral surface)
This forms a mortise for the trochlea of the
Ligaments & Joint Capsule
[edit | edit source]
Muscles[edit | edit source]
Function[edit | edit source]
Motions Available[edit | edit source]
The syndesmosis ligament complex function:
- maintains the integrity between the distal tibia and fibula
- resist forces (axial, rotational and translational) that attempt to seperate the two bones
| LIGAMENT | DESCRIPTION | PROXIMAL ATTACHMENT | DISTAL ATTACHMENT | ROLE / FUNCTION |
| Distal anterior tibiofibular ligament (ATIFL)[3] |
Trapezoid shape (the tibial insertion is wider). The ligament runs obliquely. |
Anterior tubercle of the distal tibia | Anterior surface of the distal fibula at the lateral malleolus | |
| Posterior or posterior-inferior tibiofibular ligament (PTIFL)[4] |
Strong compact ligament. Known as the Superficial component of the PTIFL. |
Posterior edge of the lateral malleolus |
Posterior tibial tubercle. | |
|
Transverse ligament or the Transverse tibio-fibular ligament (TTFL)[4] |
Cone shaped. Also known as the Deep component of the PTIFL.
|
Proximal area of the malleolar fossa | Posterior edge of the tibia -- directly posterior to the cartilaginous covering of the inferior tibial articular surface and may extent up to the medial malleolus. | Forms a true labrum. Provides talocrural joint stability. Prevents Posterior translation |
| 4 | ||||
| 5 |
The superficial component originates at the posterior edge of the lateral malleolus and directs proximally and medially to insert in the posterior tibial tubercle. This component would be homologous to the anterior tibiofibular ligament. The term posterior or posteroinferior tibiofibular ligament is usually used to refer to the superficial component (Figs. 20, ,2121).
The deep component is cone shaped and originates in the proximal area of the malleolar fossa to insert in the posterior edge of the tibia. Its insertion is immediately posterior to the cartilaginous covering of the inferior tibial articular surface; the fibers may reach the medial malleolus (Fig. 21). This component is also known as the transverse ligament, forming a true labrum [36] to provide talocrural joint stability and to prevent posterior talar translation [37].
Range of Motion[edit | edit source]
Closed Packed Position[edit | edit source]
Open Packed Position[edit | edit source]
Osteokinematics[edit | edit source]
Arthrokinematics[edit | edit source]
Pathology/Injury[edit | edit source]
{Although the syndesmosis is a joint, in the literature the term syndesmotic injury is used to describe injury of the syndesmotic ligaments.[1]}link
Clinical conditions
high ankle sprain & syndesmosis injury
ankle fracture
Techniques[edit | edit source]
Palpation[edit | edit source]
Examination[edit | edit source]
Treatment[edit | edit source]
Resources[edit | edit source]
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ 1.0 1.1 1.2 Hermans JJ, Beumer A, De Jong TA, Kleinrensink GJ. Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach. Journal of anatomy. 2010 Dec 1;217(6):633-45.
- ↑ Lin CF, Gross MT, Weinhold P. Ankle syndesmosis injuries: anatomy, biomechanics, mechanism of injury, and clinical guidelines for diagnosis and intervention. Journal of Orthopaedic &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Sports Physical Therapy. 2006 Jun;36(6):372-84.
- ↑ Ebraheim NA, Taser F, Shafiq Q, Yeasting RA. Anatomical evaluation and clinical importance of the tibiofibular syndesmosis ligaments. Surgical and Radiologic Anatomy. 2006 May 1;28(2):142-9.
- ↑ 4.0 4.1 Golanó P, Vega J, De Leeuw PA, Malagelada F, Manzanares MC, Götzens V, Van Dijk CN. Anatomy of the ankle ligaments: a pictorial essay. Knee Surgery, Sports Traumatology, Arthroscopy. 2010 May 1;18(5):557-69.
