Distal tibiofibular syndesmosis injury

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Distal tibiofibular syndesmosis injuries are a relatively frequent ankle injury, although less common than a fracture or lateral collateral ligament injuries. They are estimated to make up ~10% (range 1-20%) of ankle injuries.

Pathology

The mechanism of injury is uncertain but thought to be the combination of foot external rotation and leg internal rotation ². Injuries can occur to one or more of the distal syndesmosis structures ¹:

Associations

anterior talofibular ligament injury
fracture / bone contusion
talar dome osteochondral injury ²

Radiographic features

Plain radiograph

~~widening~~
Widening/diastasis of the distal tibiofibular joint may be seen but the absence does not rule out a syndesmotic injury ^2,3. Numerous measurements have been proposed but these vary across studies with no consensus formed. Some studies have shown ³:
- tibiofibular clear space >5.3 mm (AP view) has a sensitivity of 82% and specificity of 75% for syndesmotic injuries
- tibiofibular overlap
  - <10 mm (AP view)
  - <2.8 mm (mortise view) has a sensitivity of 36% and specificity of 87% for syndesmotic injuries
- medial clear space >4.5 mm (mortise view) is considered indicative of deltoid ligament rupture and an indirect sign of a syndesmotic injury
Ultrasound
- can demonstrate anterior inferior tibiofibular ligament injury ³
MRI

MRI has been shown to accurately detect injuries to the ligamentous structures of the distal tibiofibular syndesmosis ^1-3:.

~~anterior inferior tibiofibular ligament (AITFL)~~

~~posterior inferior tibiofibular ligament (PITFL)~~

~~transverse tibiofibular ligament~~

~~interosseous tibiofibular ligament~~

-<p><strong>Distal tibiofibular syndesmosis injuries</strong> are a relatively frequent ankle injury, although less common than a <a title="Ankle fractures" href="/articles/ankle-fractures-1">fracture</a> or <a title="Lateral collateral ligament of the ankle" href="/articles/lateral-collateral-ligament-of-the-ankle">lateral collateral ligament</a> injuries. </p><h4>Radiographic features</h4><h5>Plain radiograph</h5><ul><li>widening of the distal tibiofibular joint</li></ul><h5>MRI</h5><p>MRI has been shown to accurately detect injuries to the ligamentous structures of the distal tibiofibular syndesmosis <sup>1</sup>:</p><ul>
~~-<li><a title="anterior inferior tibiofibular ligament (AITFL)" href="/articles/anterior-inferior-tibiofibular-ligament-aitfl">anterior inferior tibiofibular ligament (AITFL)</a></li>~~
~~-<li><a title="posterior inferior tibiofibular ligament (PITFL)" href="/articles/posterior-inferior-tibiofibular-ligament-pitfl">posterior inferior tibiofibular ligament (PITFL)</a></li>~~
~~-<li><a title="transverse tibiofibular ligament" href="/articles/transverse-tibiofibular-ligament">transverse tibiofibular ligament</a></li>~~
~~-<li><a title="interosseous tibiofibular ligament" href="/articles/interosseous-tibiofibular-ligament">interosseous tibiofibular ligament</a></li>~~
~~-</ul>~~
+<p><strong>Distal tibiofibular syndesmosis injuries</strong> are a relatively frequent ankle injury, although less common than a <a href="/articles/ankle-fractures-1">fracture</a> or <a href="/articles/lateral-collateral-ligament-of-the-ankle">lateral collateral ligament</a> injuries. They are estimated to make up ~10% (range 1-20%) of ankle injuries. </p><h4>Pathology</h4><p>The mechanism of injury is uncertain but thought to be the combination of foot external rotation and leg internal rotation <sup>2</sup>. Injuries can occur to one or more of the distal syndesmosis structures <sup>1</sup>: </p><ul>
+<li><a href="/articles/anterior-inferior-tibiofibular-ligament-aitfl">anterior inferior tibiofibular ligament (AITFL)</a></li>
+<li><a href="/articles/posterior-inferior-tibiofibular-ligament-pitfl">posterior inferior tibiofibular ligament (PITFL)</a></li>
+<li><a href="/articles/transverse-tibiofibular-ligament">transverse tibiofibular ligament</a></li>
+<li><a href="/articles/interosseous-tibiofibular-ligament">interosseous tibiofibular ligament</a></li>
+</ul><h5>Associations</h5><ul>
+<li><a href="/articles/anterior-talofibular-ligament-injury">anterior talofibular ligament injury</a></li>
+<li>
+<a href="/articles/ankle-fractures-1">fracture</a> / bone contusion</li>
+<li>talar dome osteochondral injury <sup>2</sup>
+</li>
+</ul><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Widening/diastasis of the distal tibiofibular joint may be seen but the absence does not rule out a syndesmotic injury <sup>2,3</sup>. Numerous measurements have been proposed but these vary across studies with no consensus formed. Some studies have shown <sup>3</sup>:</p><ul>
+<li>
+<a href="/articles/tibiofibular-clear-space">tibiofibular clear space</a> >5.3 mm (AP view) has a sensitivity of 82% and specificity of 75% for syndesmotic injuries</li>
+<li>
+<a href="/articles/tibiofibular-overlap">tibiofibular overlap</a> <ul>
+<li><10 mm (AP view)</li>
+<li><2.8 mm (mortise view) has a sensitivity of 36% and specificity of 87% for syndesmotic injuries</li>
+</ul>
+</li>
+<li>
+<a href="/articles/medial-clear-space">medial clear space</a> >4.5 mm (mortise view) is considered indicative of deltoid ligament rupture and an indirect sign of a syndesmotic injury</li>
+</ul><h5>Ultrasound</h5><ul><li>can demonstrate <a href="/articles/anterior-inferior-tibiofibular-ligament">anterior inferior tibiofibular ligament</a> injury <sup>3</sup>
+</li></ul><h5>MRI</h5><p>MRI has been shown to accurately detect injuries to the ligamentous structures of the distal tibiofibular syndesmosis <sup>1-3</sup>.</p>

References changed:

1. Oae K, Takao M, Naito K et al. Injury of the Tibiofibular Syndesmosis: Value of MR Imaging for Diagnosis. Radiology. 2003;227(1):155-61. <a href="https://doi.org/10.1148/radiol.2271011865">doi:10.1148/radiol.2271011865</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/12616009">Pubmed</a>
2. Brown K, Morrison W, Schweitzer M, Parellada J, Nothnagel H. MRI Findings Associated with Distal Tibiofibular Syndesmosis Injury. AJR Am J Roentgenol. 2004;182(1):131-6. <a href="https://doi.org/10.2214/ajr.182.1.1820131">doi:10.2214/ajr.182.1.1820131</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/14684526">Pubmed</a>

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sports
sports medicine
sports injury

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