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 ( | 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 (PITFL) 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; Sports Physical Therapy. 2006 Jun;36(6):372-84.</ref> | ||
<br> | <br> | ||
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*Distal tibia (the triangular notch of the lateral surface) | *Distal tibia (the triangular notch of the lateral surface) | ||
This forms a mortise for the trochlea of the | This forms a mortise for the trochlea of the Talus | ||
=== Ligaments & | |||
At the base of the syndesmosis there is a small area where the tibia and fibula are in direct contact. This area is called the tibiofibular contact zone. Its facets are covered with a small strip of hyaline cartilage about 0.5–1.0 mm thick (Lanz & Wachsmuth, 1972; Kelikian & Kelikian, 1985; Bartonicek, 2003; Ebraheim et al. 2006) (Figs 2 and and3).3). The tibial cartilage rim is a continuation of the cartilage covering the tibial plafond and is 3–9 mm in length and about 2–5 mm in height. The rim of fibular cartilage is continuous with the articular facet of the fibular malleolus. | |||
=== Ligaments & Interosseus membrane<br> === | |||
<br> | <br> | ||
'''INTEROSSEUS MEMBRANE:''' | |||
Function: | |||
*The inferior segment assists in stabilising the tibiofibular syndesmosis. | |||
<br> | <br> | ||
{| width="100" border="1" align="left" cellpadding="1" cellspacing="1" | {| width="100" border="1" align="left" cellpadding="1" cellspacing="1" | ||
|+ SYNDESMOSIS LIGAMENTS | |+ '''SYNDESMOSIS LIGAMENTS''' | ||
|- | |- | ||
! scope="col" width="100" align="left" bgcolor="#cccccc" | | ! scope="col" width="100" align="left" bgcolor="#cccccc" | LIGAMENTS | ||
! scope="col" width="100" align="left" bgcolor="#cccccc" | | ! scope="col" width="100" align="left" bgcolor="#cccccc" | '''DESCRIPTION''' | ||
! scope="col" width="100" align="left" bgcolor="#cccccc" | | ! scope="col" width="100" align="left" bgcolor="#cccccc" | '''PROXIMAL ATTACHMENT''' | ||
! scope="col" width="100" align="left" bgcolor="#cccccc" | | ! scope="col" width="100" align="left" bgcolor="#cccccc" | '''DISTAL ATTACHMENT''' | ||
! scope="col" width="100" align="left" bgcolor="#cccccc" | | ! scope="col" width="100" align="left" bgcolor="#cccccc" | '''ROLE / FUNCTION''' | ||
|- | |- | ||
| | | | ||
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The ligament runs obliquely. | The ligament runs obliquely. | ||
Weaker than the PITFL. | |||
| Anterior tubercle of the distal tibia | | Anterior tubercle of the distal tibia | ||
| Anterior surface of the distal fibula at the lateral malleolus | | Anterior surface of the distal fibula at the lateral malleolus | ||
| | | | ||
One of the primary stabilisers. | |||
<br>Limits excessive: | <br>Limits excessive: | ||
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Posterior or posterior-inferior tibiofibular ligament | Posterior or posterior-inferior tibiofibular ligament | ||
( | (PITFL) | ||
| | | | ||
Strong compact ligament. | Strong compact ligament. | ||
Known as the Superficial component of the | Known as the Superficial component of the PITFL. | ||
| | | | ||
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| Posterior tibial tubercle. | | Posterior tibial tubercle. | ||
| | | | ||
One of the primary stabilisers. | |||
Limits excessive:<br> | Limits excessive:<br> | ||
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(IOL) | (IOL) | ||
| Thickened portion of the distal interosseous membrane. | |||
| | | | ||
| | | | ||
| | | | ||
One of the primary stabilisers. | |||
Buffer to axial tibial loading (from weight bearing) as it transfers some of the axial compressive load to the fibula. | |||
|- | |- | ||
| 5 | | 5 | ||
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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><ref name="Lin" /><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> | ||
<br> | |||
<br> | <br> | ||
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*Provide strong stabilization and dynamic support to the ankle mortise | *Provide strong stabilization and dynamic support to the ankle mortise | ||
*Maintain the integrity between the distal tibia and fibula | *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" /> | *Resist forces (axial, rotational and translational) that attempt to seperate the two bones <ref name="Lin" /><ref name="Ebraheim" /><ref name="Golano" /> | ||
=== Motions Available<br> === | === Motions Available<br> === | ||
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Clinical conditions<br>high ankle sprain & syndesmosis injury <br>ankle fracture | Clinical conditions<br>high ankle sprain & syndesmosis injury <br>ankle fracture | ||
{Injury to the AITFL is usually accompanied by a tear of the interosseous ligament.26 Lin} | |||
{Mechanical disruption of the interosseous ligament and membrane may result in increased compressive stress within the tibia, increased likeli- hood of lateral dislocation of the distal fibula, and incongruence of the ankle joint articulating sur- faces.59 Dynamic ankle joint motion and relative joint position of the talus within the mortise would be altered under these circumstances, resulting in abnor- mal distribution of contact pressure and the possible development of joint arthritis. Lin} | |||
== Techniques == | == Techniques == | ||
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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 (PITFL) 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 Talus
At the base of the syndesmosis there is a small area where the tibia and fibula are in direct contact. This area is called the tibiofibular contact zone. Its facets are covered with a small strip of hyaline cartilage about 0.5–1.0 mm thick (Lanz & Wachsmuth, 1972; Kelikian & Kelikian, 1985; Bartonicek, 2003; Ebraheim et al. 2006) (Figs 2 and and3).3). The tibial cartilage rim is a continuation of the cartilage covering the tibial plafond and is 3–9 mm in length and about 2–5 mm in height. The rim of fibular cartilage is continuous with the articular facet of the fibular malleolus.
Ligaments & Interosseus membrane
[edit | edit source]
INTEROSSEUS MEMBRANE:
Function:
- The inferior segment assists in stabilising the tibiofibular syndesmosis.
| LIGAMENTS | DESCRIPTION | PROXIMAL ATTACHMENT | DISTAL ATTACHMENT | ROLE / FUNCTION |
|---|---|---|---|---|
|
Distal anterior tibiofibular ligament (ATIFL) |
Trapezoid shape (the tibial insertion is wider). The ligament runs obliquely.
Weaker than the PITFL. |
Anterior tubercle of the distal tibia | Anterior surface of the distal fibula at the lateral malleolus |
One of the primary stabilisers.
|
|
Posterior or posterior-inferior tibiofibular ligament (PITFL) |
Strong compact ligament. Known as the Superficial component of the PITFL. |
Posterior edge of the lateral malleolus |
Posterior tibial tubercle. |
One of the primary stabilisers. 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) |
Thickened portion of the distal interosseous membrane. |
One of the primary stabilisers. Buffer to axial tibial loading (from weight bearing) as it transfers some of the axial compressive load to the fibula. | ||
| 5 |
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][3]
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
{Injury to the AITFL is usually accompanied by a tear of the interosseous ligament.26 Lin}
{Mechanical disruption of the interosseous ligament and membrane may result in increased compressive stress within the tibia, increased likeli- hood of lateral dislocation of the distal fibula, and incongruence of the ankle joint articulating sur- faces.59 Dynamic ankle joint motion and relative joint position of the talus within the mortise would be altered under these circumstances, resulting in abnor- mal distribution of contact pressure and the possible development of joint arthritis. Lin}
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; Sports Physical Therapy. 2006 Jun;36(6):372-84.
- ↑ 3.0 3.1 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.
