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The Distal Tibiofibular Ankle Syndesmosis: A Qualitative and Quantitative Anatomical Investigation Brady T. Williams, BS; Annette B. Ahrberg, MD; Mary T Goldsmith, MSc; Kevin J. Campbell, MD; Lauren Shirley; Coen A. Wijdicks, Ph.D; Robert F. LaPrade, MD, Ph.D; Thomas O. Clanton, MD

The Distal Tibiofibular Ankle Syndesmosis: A Qualitative and

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Page 1: The Distal Tibiofibular Ankle Syndesmosis: A Qualitative and

The Distal Tibiofibular Ankle

Syndesmosis: A Qualitative and

Quantitative Anatomical

Investigation

Brady T. Williams, BS; Annette B. Ahrberg, MD; Mary T

Goldsmith, MSc; Kevin J. Campbell, MD; Lauren Shirley;

Coen A. Wijdicks, Ph.D; Robert F. LaPrade, MD, Ph.D;

Thomas O. Clanton, MD

Page 2: The Distal Tibiofibular Ankle Syndesmosis: A Qualitative and

The Distal Tibiofibular Ankle Syndesmosis: A

Qualitative and Quantitative Anatomical Investigation

Thomas O. Clanton, MD

My disclosure is in the Final AOFAS Mobile App.

I have potential conflicts with this presentation due to

consultancy for Arthrex Inc. and Stryker.

The Steadman Philippon Research Institute is a 501(c)(3) non-profit institution supported

financially by private donations and corporate support from the following entities: Smith &

Nephew, Arthrex, Inc., Siemens Medical Solutions USA, Inc., ConMed Linvatec, Össur

Americas, Synthes, Ceterix Orthopaedics, Inc., AANA, University of Oslo, The Steadman

Clinic, Vail Valley Medical Center

Page 3: The Distal Tibiofibular Ankle Syndesmosis: A Qualitative and

Background

• Syndesmosis sprains can contribute to

chronic pain and instability, and often

require operative treatment

• Currently, the literature lacks sufficient

objective data detailing the complex

anatomy and localized osseous landmarks

essential for current surgical techniques1,4

Page 4: The Distal Tibiofibular Ankle Syndesmosis: A Qualitative and

Purpose

• To qualitatively and quantitatively analyze the

anatomy of the three syndesmotic ligaments,

including the anterior inferior tibiofibular ligament

(AITFL), posterior inferior tibiofibular ligament

(PITFL), and the interosseous tibiofibular

ligament (ITFL) with respect to surgically

relevant bony landmarks

Page 5: The Distal Tibiofibular Ankle Syndesmosis: A Qualitative and

Methods • Sixteen ankle specimens were dissected to identify

the anterior inferior tibiofibular ligament (AITFL),

posterior inferior tibiofibular ligament (PITFL),

interosseous tibiofibular ligament (ITFL), and bony

anatomy

• Ligament lengths, footprints, and orientations were

measured in reference to bony landmarks using an

anatomically based coordinate system and a three

dimensional coordinate measuring device and

reported as means with 95% confidence intervals2-3,5

Page 6: The Distal Tibiofibular Ankle Syndesmosis: A Qualitative and

Anterior Inferior Tibiofibular Ligament

• Present in all specimens

• Minimum and median of 3

bands

• Attached along the distolateral

margin of the anterolateral

tibial tubercle – Tibial footprint: 33.2 [30.3, 36.1] mm2

• Attached on the anterior

border of the fibula. – Fibular footprint: 34.2 [30.2, 38.1] mm2

Anterolateral Tibial (Tillaux-Chaput) Tubercle

Inferior Tip Lateral Malleolus

6.5 mm

30.5 mm

Page 7: The Distal Tibiofibular Ankle Syndesmosis: A Qualitative and

Posterior Inferior Tibiofibular Ligament

• Present in all specimens – Both superficial and deep constituents

• Superficial Fibers – Attached along inferior margin of the

posterolateral tibial tubercle and

posterior fibular border

8.3 mm

7.9 mm

11.1 mm

15.4 mm

Posterior Fibular Fossa

Posterolateral Tubercle

Proximal Prominence

Distal Prominence

7.8 mm

– Tibial footprint: 84.5 [76.8, 92.3] mm2

– Fibular fooprint: 108.1 [96.0, 120.1] mm2

• Deep fibers

– Attached inferior and medial to superfical fibers along the

tibial plafond and immediately proximal to the posteror

fibular fossa

– Tibial footprint: 52.2 [44.8, 59.6] mm2

Fibular footprint: 53.9 [47.3, 60.6] mm2

Page 8: The Distal Tibiofibular Ankle Syndesmosis: A Qualitative and

Interosseous Tibiofibular Ligament

• Present in all

specimens

• Fibrous expansion of the

distal interosseous

membrane

– Pyramidal ligamentous

network of fibers

– Originated 49.4 mm proximal

to the central aspect of the

tibial plafond

– Terminated 9.3 mm proximal

to the central aspect of the

tibial plafond

49.4 mm

9.3 mm

34.5 mm

Inferior Tip Lateral Malleolus

Page 9: The Distal Tibiofibular Ankle Syndesmosis: A Qualitative and

Synovial Recess/Articular Cartilage

• A synovial-lined joint

space was found in all

specimens – Border superiorly by the distal

border of the ITFL

• Articular Cartilage

– All specimens had an area of tibial

cartilage along the lateral aspect

of the plafond

– In 14/16 (87.5%) of specimens,

there were corresponding direct

articulating facets of tibial and

fibular cartilage along the anterior

tibiofibular joint

Anterolateral Corner Tibial Plafond

5.2 mm 3.6 mm

Inferior Tip Lateral Malleolus

30.9 mm

Page 10: The Distal Tibiofibular Ankle Syndesmosis: A Qualitative and

Conclusions

• Syndesmotic ligaments were uniform in their

locations and sites of attachment

• Qualitative and quantitative anatomy of the

syndesmosis ligaments and clinically relevant

structures was reproducibly defined with

respect to surgically relevant bony

prominences

Page 11: The Distal Tibiofibular Ankle Syndesmosis: A Qualitative and

Clinical Relevance

• Anatomic attachment sites and distances to

bony prominences can help optimize current

surgical fixation techniques, improve anatomic

restoration, and reduce the risk of iatrogenic

injury from malreduction or misplaced implants.

• Quantitative data also provides the consistency

required for the development of novel anatomic

reconstructions.

Page 12: The Distal Tibiofibular Ankle Syndesmosis: A Qualitative and

References

1. Bartonicek J. Anatomy of the tibiofibular syndesmosis and its clinical relevance. Surg Radiol Anat.

2003;25:379-386. PMID: 14504816

2. Campbell KJ, Michalski MP, Wilson KJ, Goldsmith MT, Wijdicks CA, LaPrade RF, Clanton TO. The

ligament anatomy of the deltoid complex of the ankle: a qualitative and quantitative anatomical

study. J Bone Joint Surg Am. 2014;96(8):e62. PMID: 24740670

3. Clanton TO, Campbell KJ, Wilson KJ, Michalski MP, Goldsmith MT, Wijdicks CA, LaPrade RF.

Qualitative and quantitative anatomic investigation of the lateral ankle ligaments for surgical

reconstruction procedures. J Bone Joint Surg Am. 2014;96(12):e98. [Epub ahead of print] PMID:

24951749

4. Ebraheim NA, Taser F, Shafiq Q, Yeasting RA. Anatomical evaluation and clinical importance of the

tibiofibular syndesmosis ligaments. Surg Radiol Anat. 2006;28(2):142-149. PMID: 16463081

5. Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D’Lima DD, Cristofolini L,

Witte H, Schmid O, Stokes I, Standardization and Terminology Committee of the International

Society of Biomechanics. ISB recommendation on definitions of joint coordinate system of various

joints for the reporting of human joint motion – part I: ankle, hip, and spine. International Society of

Biomechanics, J Biomech. 2002;35(4):543. PMID: 11934426