Distal Tibiofibular Syndesmosis: Difference between revisions
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A syndesmosis is a fibrous joint between two bones and linked by ligaments and a strong membrane. <ref name="Hermans">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.</ref> | A syndesmosis is a fibrous joint between two bones and linked by ligaments and a strong membrane. <ref name="Hermans">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.</ref> | ||
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 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;amp;amp; Sports Physical Therapy. 2006 Jun;36(6):372-84.</ref> | 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 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;amp;amp;amp;amp;amp;amp; Sports Physical Therapy. 2006 Jun;36(6):372-84.</ref> | ||
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=== Ligaments & Joint Capsule<br> === | === Ligaments & Joint Capsule<br> === | ||
<br> | <br> | ||
<br> | <br> | ||
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| '''ROLE / FUNCTION''' | | '''ROLE / FUNCTION''' | ||
|- | |- | ||
| Distal anterior tibiofibular ligament (ATIFL) | | | ||
Distal anterior tibiofibular ligament | |||
(ATIFL) | |||
| | | | ||
Trapezoid shape (the tibial insertion is wider). | Trapezoid shape (the tibial insertion is wider). | ||
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| Anterior surface of the distal fibula at the lateral malleolus | | Anterior surface of the distal fibula at the lateral malleolus | ||
| | | | ||
Primary stabiliser. | |||
<br>Limits excessive: | |||
*external rotation of the foot on the leg | |||
*distal fibular motion on the tibia | |||
|- | |- | ||
| Posterior or posterior-inferior tibiofibular ligament (PTIFL) | | | ||
Posterior or posterior-inferior tibiofibular ligament | |||
(PTIFL) | |||
| | | | ||
Strong compact ligament. | Strong compact ligament. | ||
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| Posterior tibial tubercle. | | Posterior tibial tubercle. | ||
| | | | ||
Primary stabiliser. | |||
Limits excessive:<br> | |||
*external rotation of the foot on the leg | |||
*distal fibular motion on the tibia | |||
|- | |- | ||
| | | | ||
Transverse ligament or the Transverse tibio-fibular ligament | Transverse ligament or the Transverse tibio-fibular ligament | ||
(TTFL) | (TTFL) | ||
<br> | |||
| | | | ||
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| 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 | | | ||
Forms a true labrum. <br> | |||
Provides talocrural joint stability. <br> | |||
Prevents Posterior translation | |||
|- | |- | ||
| | | | ||
Interosseus ligament | Interosseus ligament | ||
(IOL) | (IOL) | ||
| | | | ||
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<ref name="Golano" /><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> | <ref name="Golano" /><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><ref name="Lin" /><br> | ||
constraining excessive distal fibular motion relative to the tibia and excessive external rotation of the foot on the leg.4<br> | |||
<br> | <br> | ||
<br> | |||
=== Muscles<br> === | |||
== Function == | |||
The function of syndesmosis ligament complex: | |||
== | *Provide strong stabilization and dynamic support to the ankle mortise | ||
*Maintain the integrity between the distal tibia and fibula | |||
*Resist forces (axial, rotational and translational) that attempt to seperate the two bones <ref name="Lin" /><ref name="Ebraheim" /> | |||
=== Motions Available<br> === | === Motions Available<br> === | ||
=== Range of Motion === | |||
= | *2° fibula external rotation relative to the tibia | ||
*As the ankle joint moves from end range plantar flexion to end range dorsiflexion the ankle mortise widens only about 1mm. <ref name="Lin" /> | |||
=== Closed Packed Position === | === Closed Packed Position === | ||
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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),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]
| LIGAMENT | DESCRIPTION | PROXIMAL ATTACHMENT | DISTAL ATTACHMENT | ROLE / FUNCTION |
|
Distal anterior tibiofibular ligament (ATIFL) |
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 |
Primary stabiliser.
|
|
Posterior or posterior-inferior tibiofibular ligament (PTIFL) |
Strong compact ligament. Known as the Superficial component of the PTIFL. |
Posterior edge of the lateral malleolus |
Posterior tibial tubercle. |
Primary stabiliser. Limits excessive:
|
|
Transverse ligament or the Transverse tibio-fibular ligament (TTFL)
|
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 |
|
Interosseus ligament (IOL) |
||||
| 5 |
constraining excessive distal fibular motion relative to the tibia and excessive external rotation of the foot on the leg.4
Muscles
[edit | edit source]
Function[edit | edit source]
The function of syndesmosis ligament complex:
- Provide strong stabilization and dynamic support to the ankle mortise
- Maintain the integrity between the distal tibia and fibula
- Resist forces (axial, rotational and translational) that attempt to seperate the two bones [2][4]
Motions Available
[edit | edit source]
Range of Motion[edit | edit source]
- 2° fibula external rotation relative to the tibia
- As the ankle joint moves from end range plantar flexion to end range dorsiflexion the ankle mortise widens only about 1mm. [2]
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.
- ↑ 2.0 2.1 2.2 2.3 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;amp;amp;amp;amp;amp; Sports Physical Therapy. 2006 Jun;36(6):372-84.
- ↑ Cite error: Invalid
<ref>tag; no text was provided for refs namedGolano - ↑ 4.0 4.1 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.
