Distal tibiofibular syndesmotic injury - subacute

Case contributed by Dr Henry Knipe


Ongoing ankle pain 8 weeks post sports injury.

Patient Data

Age: 18 years
Gender: Male

Small ankle joint effusion. No fracture. Widening of the distal syndesmosis on the mortise view. 

Small ankle joint effusion. No posterior subtalar joint effusion. No osteochondral injury of the talar dome or distal tibial plafond.

Mild hyperintensity of the distal tibiofibular syndesmosis. Anterior and posterior distal tibiofibular ligaments are intact but heterogeneous and hyperintense. Marrow edema at the insertion of the posterior distal tibiofibular ligament onto the posterior malleolus of the tibia. No T1 hypointense fracture line is identified. 

TightRopeTM internal fixation of the distal tibiofibular syndesmosis. Alignment is anatomical. No fracture. 

Case Discussion

The MRI demonstrates grade 2 AITFL and PITFL injuries, although these could be healing grade 3 injuries given the timeframe (8 weeks) from injury. The distal tibiofibular syndesmosis is widened (best seen on the x-ray) and mildly hyperintense on the MRI. 

Disclosure: I, Henry Knipe, have no actual or potential ethical or financial conflict of interest in relation to the TightRopeTM device. This case is not intended to be a personal endorsement or recommendation of this product.

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Case information

rID: 68182
Published: 18th May 2019
Last edited: 20th May 2019
Inclusion in quiz mode: Included

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