Tibiofibular overlap

Last revised by Henry Knipe on 2 Feb 2022

The tibiofibular overlap (TFO) is the overlapping area between the anterior distal tibial prominence and the medial edge of the distal fibula 1-3.

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.

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.

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.

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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