The tibiofibular overlap (TFO) is the overlapping area between the anterior distal tibial prominence and the medial edge of the distal fibula 1-3.
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Usage
Together with the tibiofibular clear space (TFCS) and the medial clear space, the tibiofibular overlap space has been used in the diagnosis and syndesmotic injury 1-3 and the syndesmotic assessment after repair 2.
Measurement
This measurement can be made on AP or mortise projections 5. The horizontal distance between the lateral margin of the anterior tubercle and the medial contour of the fibula is measured parallel and about 1 cm above the distal tibial plafond in a normal anteroposterior view of the ankle 1-3.
Interpretation
In the context of an enlarged tibiofibular clear space and a widened medial clear space, a tibiofibular overlap of <0 mm is considered abnormal 1 although has been reported as a normal variant 6.
Practical points
Like with the tibiofibular clear space, there is some debate about the actual ability of those measures to really predict syndesmotic injury 1,2,4.
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