What Is the Latest With the Distal Tibiofibular Syndesmosis?

Background: Syndesmotic injuries, also known as “high ankle sprains,” account for about 10% of all ankle sprains. They are critical to identify in order to have appropriate management that minimizes long-term functional impairment, chronic instability, and early osteoarthritis. The distal fibular syndesmosis is a fibrous joint stabilized by ligamentous structures and creates the ankle mortise for the talus. Objective: To review anatomy, biomechanics, and imaging appearance of syndesmotic injuries. Discussion: The authors review anatomy in detail, including ligamentous structures such as the anterior–inferior tibiofibular, posterior–inferior tibiofibular, and intermalleolar ligaments. First-line imaging is with radiography, with weight-bearing anteroposterior, lateral, and mortise views necessary to assess for fractures and diastasis. Tibiofibular and medial clear spaces are normally ≤6 and 4 mm, respectively. MRI is the standard imaging modality to assess for ligamentous injury and c more...