Anterolateral Ankle Impingement Research Articles

A hypertrophic distal fascicle of the anterior tibiofibular ligament is associated with a high rate of osteochondral lesions of the talus.

The purpose of this retrospective review was to determine the prevalence of osteochondral lesions (OCLs) of the lateral talar dome in patients with anterior ankle impingement with an associated hypertrophic distal fascicle of the anterior tibio-fibular ligament. Retrospective chart review identified 40 patients who underwent anterior ankle arthroscopy for the management of anterior ankle impingement. Clinical outcomes assessed includedpre- and postoperative foot and ankle outcome score (FAOS), visual analogue scale (VAS), complications, failures, secondary surgical procedures, return-to-work data and return-to-sport data. Thirty-two patients with a mean follow-up time of 29.3 ± 10.4 months were included. The hypertrophic distal fascicle of the anterior tibio-fibular ligament was hypertrophic in 29 patients (90.6%), with a mean thickness of 2.5 ± 0.4 mm on MRI. There were 22 OCLs of the lateral talar dome (75.9%) with an associated hypertrophic distal fascicle of the anterior tibio-fibular ligament visualized during arthroscopy. The international cartilage repair society gradings of the lesions included3 (13.6%) grade I lesions, 15 (68.1%) grade II lesions, 3 (13.6%) grade III lesions, and 1 (4.6%) grade IV lesion. There was a statistically significant improvement in mean FAOS and VAS scores from preoperative to postoperative (p < 0.001). No cases of syndesmotic instability were observed following resection of hypertrophic distal fascicle of the anterior tibio-fibular ligament. This retrospective case series demonstrated that a hypertrophic distal fascicle of the anterior tibio-fibular ligament was associated with an OCL of the lateral talar dome identified during arthroscopic evaluation. In addition, preoperative MRI demonstrated poor sensitivity for the detection of these OCLs. Heightened awareness is warranted for potential lateral talar dome OCLs in patients presenting with anterolateral ankle impingement with a hypertrophic ATiFLdf identified on preoperative MRI in the absence of an associated OCLs. Level IV, Retrospective case series.

Anterolateral Ankle Impingement due to Bassett’s Ligament

Category: Arthroscopy; Ankle Introduction/Purpose: The Bassett’s ligament, an accessory band of the anterior inferior tibiofibular ligament (AITFL), is known to be a normal ligamentous structure present in 21-92% of cases. The Bassett’s ligament is also known as a structure that causes anterolateral impingement of the ankle joint after an ankle sprain. However, not much is known about the cause or prognosis of anterolateral impingement by Bassett's ligament. In this study, the symptoms, characteristics, and postoperative results of impingement by Bassett's ligament were reported. Methods: From November 2017 to August 2021, 12 patients who underwent surgical treatment for pain in the anterolateral aspect of the ankle joint, which did not improve with conservative treatment, were enrolled. There were 5 males and 7 females, and the average age was 34.4 years (21-76). The symptoms complained of by the patients and accompanying injuries were analyzed. And the arthroscopic findings and postoperative results were analyzed. Results: All patients had a history of ankle sprain before symptoms. All patients complained of pain and tenderness in the anterolateral aspect of the ankle joint, and the pain improved after injection of lidocaine. And 3 patients (25%) complained of snapping during ankle ROM. Ankle instability was present in 10 patients (83.3%), and OLT was present in 2 patients (16.7%). Arthroscopic findings showed that the Bassett’s ligament impinged with the anterolateral aspect of the talar dome during ROM in all cases. And synovitis was found around the Bassett ligament in all cases, fraying of the Bassett ligament in 5 cases (41.7%), and fraying of the cartilage of the dome of the talus in 4 cases (33.3%). Anterolateral ankle pain disappeared in all patients after surgery. Conclusion: Impingement between the talar dome and the Bassett’s ligament should be considered as one of the causes of anterolateral ankle pain, especially in patients with ankle sprains.

Effectiveness of Arthroscopic Decompression in Treatment of Anterolateral Ankle Impingement Syndrome: A Systematic Review

Background Soft tissue impingement of the ankle is a common cause of chronic ankle pain that usually arises at the lateral and/or anterolateral compartment of the ankle joint after an inversion injury. Approximately 3% of ankle sprains may lead to anterolateral impingement. Aim of the Work In this systemic review we aimed to highlight the prevalence of ankle impingement syndrome, and to evaluate the effectiveness of arthroscopic decompression in such instance. Material and Methods A total of 246 cases were included 135 were males and mean age was 29.6 years, The mean follow up period among included studies was 29.5 months min-max 15-83.7. The main complaint was pain, ankle swelling, limited ankle movement and limited functional activity. Mean AOFAS score pre was 40.75 which increased post treatment to 84.2. Results According to Meislen criteria patients showed excellent (n124), good (n71) fair (n 14), poor (n3). As regard mobility patients showed after treatment normal (n 130), persistent pain (n24), painful limited dorsiflexion at 15(n2). Complications founded among 24 cases after treatment in form of hypoesthesia in 4 cases, infection in 2 cases, injuries in 7 cases, Intraarticular haemarthros in 1 case, consistent GW attacks in 4 cases, abnormal scar tissue in 3 cases, nerve irritation in 1 case, numbness in 2 cases. Patients were highly satisfied Conclusion In conclusion, we believe that arthroscopic debridement of the anterolateral impingement soft tissues are a good and effective method of treatment. Arthroscopic treatment of anterolateral ankle impingement gives significant therapeutic benefits on pain management and rapid resumption of daily physical and sports activities. Technically, distraction is not required which reduces the frequency of complications. The outcome was satisfactory in most cases, with marked improvement of pain and function. The procedure proved to be safe, with minimal morbidity and few complications. This procedure proved to be safe and effective, with minimal morbidity and few complications so it is recommended in Patients with persistent pain, tenderness, and feelings of instability after conservative treatment are excellent candidates for arthroscopy.

Effectiveness of Arthroscopic Decompression in the Treatment of Anterolateral Ankle Impingement Syndrome: A Systematic Literature Review

Effectiveness of Arthroscopic Decompression in the Treatment of Anterolateral Ankle Impingement Syndrome: A Systematic Literature Review

Simple distraction method for ankle arthroscopy

Ankle arthroscopy has been a frequently used procedure in settings such as osteochondral lesions of the talus (OLT), anterolateral ankle impingement, arthroscopic-assisted arthrodesis and removal of loose bodies. Tibiotalar joint is a joint too narrow for camera entry or using instruments. Therefore, these procedures, particularly the treatment of the OLT, requires a non-invasive and simple method of distraction more suitable to obtain a clear visualization. In this technical note, we aimed to describe a novel, easy to install and useful non-invasive distraction method designed to meet these requirements in anterior ankle arthroscopy under operating room conditions.

Arthroscopic treatment of anterolateral ankle soft-tissue impingement in athletes

Background Ankle sprains are the most common musculoskeletal injuries that occur in athletes. Although often considered minor, they can lead to development of chronic anterolateral soft-tissue ankle impingement. This ankle sprain if left untreated, owing to repetitive actions, can lead to development of thickenings ‘pathological synovial or capsular tissue’ within the ankle joint, which causes persistent painful limitation of ankle movement as a result of entrapment of this pathological tissues in the anterolateral aspect of the joint. As impingement progresses, movements essential to athletes may become impossible; therefore, successful arthroscopic ankle debridement and impinged-soft tissue excision is the procedure of choice, allowing athletes to return fast to their previous preinjury sports activities level. Patients and methods A total of 25 elite athletes complaining of persistent anterolateral ankle pain during sports participation, who were diagnosed by history, physical examination, and magnetic resonance imaging to have anterolateral ankle impingement with unsuccessful conservative management for at least 6 months, underwent arthroscopic debridement and excision of the anterolateral impinged hypertrophic, inflamed, and scarred soft tissue. Any athlete diagnosed to have associated ankle instability or tibial or talar chondral lesion was excluded from this study. Results There were 13 right ankles and 12 left ankles. There were 14 male and 11 female patients. No bilateral cases existed. The mean duration of symptoms till operation was 8.9 months. The mean postoperative follow-up was 15 months. At the final postoperative evaluation, 23 athletes were satisfied and reparticipated in the same preinjury sports activities level without complaints, whereas two (8%) athletes were unsatisfied and retired from high-level sports activities. The mean time to return to full sports activities with high performance was 8 weeks. According to American Orthopaedic Foot and Ankle Society (AOFAS) at the final postoperative follow-up evaluation, nine patients had excellent results, 14 patients had good results, and two patients had fair results. A significant improvement of the AOFAS (P Conclusion Ankle arthroscopy is a useful and safe method in diagnosis and treatment of anterolateral soft tissue ankle impingement in elite athletes, with early return to full sports activities. Final outcome may be affected negatively with new inversion injuries during the early postoperative period.

Ultrasound-Guided Percutaneous Needle Fenestration and Corticosteroid Injection for Anterior and Anterolateral Ankle Impingement.

Ankle impingement is a common cause of chronic ankle pain. We retrospectively studied the effectiveness of ultrasound-guided percutaneous needle fenestration of the pathological soft tissues combined with corticosteroid injection to treat this condition. We administered a telephone survey to patients who underwent the procedure. Patients were asked questions on the Foot Function Index and queried about their overall satisfaction with the procedure on a scale of 0 (completely unsatisfied) to 10 (very satisfied). Forty-nine patients participated in the survey: 26 women and 23 men, mean age 42.7 years (range, 19-65 years). Impingement was anterior in 26/49 (53.1%), anterolateral in 14/49 (28.6%), and both in 9/49 (18.4%). Mean pain level before the procedure was 6.76 ± 1.84 and after the procedure was 2.73 ± 2.21. Reported pain scale levels declined by 4.02 ± 2 units after the procedure (P < .0001). Patient's overall satisfaction was 7.9 ± 2.44. Ultrasound-guided percutaneous needle fenestration and corticosteroid injection appears to be an effective nonoperative alternative for treatment of anterior and/or anterolateral ankle impingement. Level IV.

Role of magnetic resonance imaging in the diagnosis of ankle impingement

Objectives This study aimed to a ssess the role of MRI in the diagnosis of ankle impingement. Background Ankle pain is a common and frequently disabling clinical complaint that may be caused by a broad spectrum of osseous or soft-tissue disorders. Chronic ankle pain is a common complaint in orthopedic practice. Impingement syndromes are considered one of the most important causes of chronic ankle pain, which occur due to friction of the joint tissues. Patients and methods This prospective study included 86 patients (M/F = 60/26) with chronic ankle pain and clinically suspected to have impingement. MRI acquired on a 1.5 T scanner was applied for all cases. Results Different types of ankle impingement were observed: posterior ankle impingement (n = 34/90), anterolateral ankle impingement (n = 18/90), anterior ankle impingement (n = 8/90), anteromedial ankle impingement (n = 4/90), posteromedial ankle impingement (n = 2/90), entrapment neuropathy (n = 12/90), and sinus tarsi syndrome (n = 4/90). Conclusion With the advent of MRI, detailed examination of the osseous and soft-tissue structures of the ankle is possible. Thus, MRI has opened a new horizon in diagnosis and hence in the treatment of most ankle joint lesions.

Current concepts review: Arthroscopic treatment of anterior ankle impingement.

Anterior ankle impingement is a common cause of chronic ankle pain, particularly in athletic populations. Morris and McMurray provided the earliest descriptions of anterior impingement, coining the condition as "athlete's ankle" or "footballer's ankle". The pathology has since been a topic of considerable investigation and has been re-termed "anterior ankle impingement syndrome". Treatment with open surgery has provided good results historically, but at the price of significant complications. Advancements in ankle arthroscopy have decreased the risk of complication drastically and evidence in the literature indicates that anterior arthroscopy is an effective approach to treating osseous and soft tissue impingement. Effective clinical diagnosis and diagnostic imaging are critical for pre-surgical planning. Preoperative detection of anterior osteophytes has been correlated with outcomes. Factors such as joint space narrowing and large osteophytes may also influence outcomes. Therefore, a comprehensive understanding of diagnosis and surgical technique can influence patient outcomes, and patient expectations can be managed around prognostic indicators such as the presence of osteoarthritis. The purpose of this review is to discuss the etiology, clinical presentation, diagnosis, surgical technique, and postoperative rehabilitation of anteromedial and anterolateral anterior ankle impingement syndrome and to evaluate the evidence-based outcomes of arthroscopic management.

Résultats du traitement arthroscopique des conflits tissulaires antérolatéraux de la cheville chez les sportifs : à propos d’une série de 22 cas

The origin of chronic pain after external ankle sprain is better known with arthroscopy's contribution. Chronic hypertrophic synovitis of the anterolateral ankle region is seemingly the cause, resulting in “anterolateral ankle impingement”. The authors propose the study of treatment outcomes in a retrospective series of 22 athletes with anterolateral ankle tissue conflict. We excluded all cases with bone or joint damage. The average age was 26years. Patients had anterolateral mechanical pain associated with oedema following an external ankle sprain. Medical and rehabilitative treatment has been undertaken for more than 6months before arthroscopy. No patient had ankle instability. It was no laxity on clinical examination. Computed tomography was performed in 18 cases and MRI in 4 cases. The average time between the trauma and arthroscopy was 21months. Debridement with joint lavage has been performed arthroscopically. Rehabilitation was started on the second day postoperatively. The average follow-up was 23months. According to Kitaoka score, 17 patients had an excellent result, three a good result. Arthroscopic treatment gave significant benefits on pain, oedema, as well as the resumption of sporting activities.

Distraction-free ankle arthroscopy for anterolateral impingement

The origin of chronic pain after external ankle sprain is better known with arthroscopy's contribution. Chronic hypertrophic synovitis of the anterolateral ankle region is seemingly the cause, resulting in "anterolateral ankle impingement." But is partial synovectomy with fibrosis resection under arthroscopy always possible without any distraction? Are results affected? This retrospective study concerned only patients with soft tissue ankle impingement. All cases with bone and joint diseases were excluded. The final sample of 24 patients had a mean age of 35 years (21-54 years) and presented anterolateral mechanical pain associated with oedema following external ankle sprain. Medical and rehabilitative treatment was undertaken for more than 6 months before arthroscopy. Average time between trauma and arthroscopy was 21 months (5-60 months). Clinical examination revealed no ankle instability or laxity. Debridement with joint lavage was systematically performed under arthroscopy without any distraction. Average patient follow-up was 22 months (12-92 months). All patients had a good Kitaoka score, with 22 patients registering excellent results. There were no septic complications or algodystrophy. Two transient hypoesthesias were observed in the dorsal surface and lateral border of the foot with full postoperative recovery at 6 months. Distraction was never used and simple dorsiflexion was sufficient to perform arthroscopic debridement. In this study, anterolateral ankle impingement diagnosis was primarily clinical. Arthroscopic treatment yielded significant benefits on pain, oedema and resumption of sport activities. Arthroscopic treatment of anterolateral ankle impingements is thus possible with simple dorsiflexion and no distraction, resulting in a possible decrease in complication rates. Level of evidence Retrospective cohort study, Level IV.

MRI Evaluation of Anterolateral Soft Tissue Impingement of the Ankle

The usefulness of magnetic resonance imaging (MRI) has been questioned in evaluating patients with chronic ankle sprain pain. The purpose of this study was to determine the effectiveness and reliability of routine MR imaging in the diagnosis of anterolateral soft tissue impingement. Inclusion criteria required that the MR examinations be performed by the same musculoskeletal radiologist after the most recent scanner upgrade and using a dedicated ankle/hindfoot coil. The surgical and MRI reports of 24 patients who had an arthroscopic diagnosis of anterolateral soft tissue impingement of the ankle were tabulated and categorized. Unlike previous studies, sagittal T1 and Short Tau Inversion Recovery (STIR) images were used primarily in the diagnosis of these lesions. Using this technique, we report a 78.9% accuracy in diagnosis, a sensitivity of 83.3% and a specificity of 78.6%. Fifty-eight percent of patients had an associated diagnosis, which in 33% of patients altered our surgical plan. Although not indicated in all cases of anterolateral ankle impingement, we advocate the use of MR imaging in complicated clinical presentations where the exclusion of additional pathology in the ankle or subtalar joint, and the confirmation of anterolateral soft tissue impingement would be beneficial.

Anterolateral Ankle Impingement: Diagnostic Performance of MDCT Arthrography and Sonography

The purpose of our study was to compare the diagnostic performance of CT arthrography and sonography in the diagnosis of anterolateral ankle impingement. Fifty-one patients with clinically suspected anterolateral ankle impingement prospectively underwent ankle sonography and CT arthrography, immediately followed by an additional ankle sonography examination to evaluate a potential joint effusion impact on diagnostic performance. CT arthrographic findings as well as sonographic findings before and after arthrography were correlated to subsequent arthroscopic appearance in 41 patients. The diagnostic performance of CT arthrography and sonography before and after joint injection was calculated using arthroscopy as the reference standard and compared using McNemar tests. The sensitivity and specificity of sonography were respectively 77% and 57% before joint injection and 85% and 71% after joint injection. Positive Doppler masses were found to be anterolateral impingements at arthroscopy in all cases (10/10), and masses of hyperechoic appearance were found not to be anterolateral impingements in all cases (3/3). The sensitivity and specificity of CT arthrography in the diagnosis of anterolateral impingement were respectively 97% and 71%. The performances of CT arthrography and ankle sonography in the diagnosis of anterolateral ankle impingement were significantly different (p = 0.006). CT arthrography is quite accurate and superior to ankle sonography in the diagnosis of anterolateral impingement. The diagnostic performance of sonography is limited, but positive Doppler appearance and hyperechogenicity, when present, could help to exclude or confirm the diagnosis.

Arthroscopic Treatment of Anterolateral Impingement of the Ankle

Anterolateral ankle impingement is due to entrapment of pathological tissues in the anterolateral aspect of the joint. The aim of this study was to evaluate the results of arthroscopic diagnosis and treatment of anterolateral ankle impingement. Twenty patients with anterolateral ankle impingement who had arthroscopic debridement were included in this prospective study, including 16 men and 4 women with a mean age of 35.8 years. Synovial hypertrophy was found in 13 patients, impinging distal fascicle of the anterior inferior tibiofibular ligament in 2 patients, torn anterior inferior tibiofibular ligament in 3 patients, and fibrofatty scar tissue in 2 patients. Seven patients had associated talar cartilage damage. Four patients had additional inversion injuries after the arthroscopic procedures. Final results were excellent in 11 patients, good in 6 patients, fair in 2 patients, and poor in 1 patient. One of the 7 patients with cartilage damage had excellent results, 5 patients had good results, and the remaining patient had fair results. Two of the 3 patients with complete tear of the anterior inferior tibiofibular ligament had fair results, and the other had a poor result. One of the 4 patients with additional inversion injuries had good results, 2 had fair results, and 1 had a poor result. In conclusion, ankle arthroscopy is useful in the diagnosis and treatment of anterolateral ankle impingement. Factors that negatively affect final outcome are associated chondral lesions of the talus, associated syndesmotic lesions, and new inversion injuries after the arthroscopic procedure.

Anterolateral Ankle Impingement in Adolescents: Outcomes of Nonoperative and Operative Treatment

Ankle sprains in adolescents usually resolve with conservative management but a few patients may develop ankle impingement syndrome. There have been adult studies addressing surgical treatment of this pathology, but our study evaluated the surgical management of anterolateral ankle impingement in adolescents by comparing their outcomes after nonoperative treatment and subsequent surgical intervention. Thirteen patients (children and adolescents) diagnosed with ankle impingement by history, physical examination, and magnetic resonance imaging during a 9-year period at our institution underwent eventual arthroscopic debridement. A retrospective chart review of these patients was performed and they were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) functional rating scale on 3 separate occasions: (1) initial presentation, (2) termination of nonoperative management, and (3) final postoperative follow-up visit. Thirteen adolescents (11 girls and 2 boys; 14 ankles) with a mean age of 15.6 (11.9-18.3) years met the inclusion criteria; of these, all had arthroscopic surgery. Mean duration of reported symptoms was 9.6 (4-15) months and mean duration of nonoperative management (physical therapy, activity modifications) was 6.9 (2-12) months. The mean AOFAS rating (out of 100 total) at initial presentation was 68.4 (40-84) and after nonoperative management was no better with a mean of 68.2 (63-76). The mean AOFAS rating at final follow-up was 90.6 (52-100), which was statistically significant (P<or=0.001). Mean time to return to full activity after surgery was 2.5 months (0.7-4.7 mo) excluding 4 patients who had delayed return or no return. Complications in these 4 patients included 2 cutaneous neuromas, 1 complex regional pain syndrome, and 1 adolescent with nonassociated chondromalacia. Knowledge of this entity is critical for making the correct diagnosis and eventual treatment. In fact, once the diagnosis of impingement is confirmed by clinical and radiographic evaluation there seems to be no significant improvement with nonsurgical treatment. Arthroscopic debridement is an accepted method of treatment and our results in adolescents echo those found in the adult literature. Functional improvement can be obtained via surgical debridement for all types of anterolateral ankle impingement in the adolescent population.

Anterolateral ankle impingement: findings and diagnostic accuracy with ultrasound imaging

The objective was to evaluate the findings and diagnostic accuracy of ultrasound in antero-lateral ankle impingement (ALI) with clinical and arthroscopic correlation. Seventeen elite footballers with chronic ankle pain were referred for ultrasound with a clinical diagnosis of ALI (n = 8) or a control condition (n = 9; lateral mechanical instability, osteochondral defect, intra-articular bodies and osteoarthritis). Ultrasound examination included the antero-lateral gutter for abnormal synovial tissue (synovitic lesion), lateral ligament integrity, tibiotalar joint and osseous spurs of the distal tibia and talus. Ultrasound findings were correlated with subsequent arthroscopic appearance. Ultrasound examination detected a synovitic mass in the antero-lateral gutter in all 8 footballers with clinical ALI (100%) and in 2 patients with a control diagnosis (22%). Arthroscopic correlation of antero-lateral synovitis and fibrosis was present in all 10 cases (100%). The synovitic lesion was seen at ultrasound as a nodular soft tissue mass of mixed echogenicity within the antero-lateral gutter, which extruded anteriorly with manual compression of the distal fibula against the tibia. Increased blood supply was detected using power Doppler imaging in only 1 patient. The synovitic lesion measured >10 mm in its maximum dimension in 7 footballers with clinical ALI and <10 mm in the control group. Additional ultrasound findings in patients with abnormal antero-lateral synovial tissue included an anterior talofibular ligament injury in all patients (n = 10), a tibiotalar joint effusion (n = 6) and osseous spurs (n = 4). Antero-lateral synovitic tissue was accurately identified at ultrasound in the absence of an effusion (n = 4). No synovitic lesion was detected at ultrasound or arthroscopy in the remaining 7 patients with a control diagnosis. Ultrasound is accurate in detecting synovitic lesions within the antero-lateral gutter, demonstrating associated ligamentous injuries and in differentiating soft tissue from osseous impingement. Synovitic lesions in two control patients suggest that abnormal antero-lateral soft tissue does not necessarily imply the presence of symptomatic ALI. Synovitic lesions in excess of 10 mm were associated with symptoms. Ultrasound will not demonstrate osteocartilaginous lesions or stress fractures and may overlook some loose bodies. Ultrasound findings together with clinical correlation can be used to direct arthroscopic examination and surgical debridement.

Impingement syndromes of the ankle

Ankle impingement syndromes are categorised according to their anatomical site around the tibiotalar joint. Anterolateral, anterior and posterior ankle impingement has been extensively described in the orthopaedic and radiology literature with more recent studies describing posteromedial and anteromedial impingement. This article aims to demonstrate the potential spectrum of imaging findings for each ankle impingement syndrome as well as the relative contributions of ultrasound and MR imaging for diagnosis and image-guided treatment.

The Accessory Anteroinferior Tibiofibular Ligament as a Cause of Talar Impingement

Background A distal fascicle of the anteroinferior tibiofibular ligament has been reported as a possible cause of anterolateral ankle impingement. Hypothesis This fascicle represents an independent accessory ligament in the anterior aspect of the inferior tibiofibular syndesmosis. Study Design Descriptive anatomical study. Methods The inferior tibiofibular syndesmosis was exposed in 24 fresh-frozen cadaveric ankles. Morphological characteristics of the inferior tibiofibular ligaments and interactions between the anterior ligaments and the talus were investigated in different degrees of ankle motion. Results A separate accessory anterior ligament was identified in 22 specimens. Its orientation was parallel and distal to the anterior tibiofibular ligament, from which it was separated by a fibrofatty septum. Its length ranged from 17 to 22 mm, its thickness from 1 to 2 mm, and its width from 3 to 5 mm. Impingement of this ligament against the talar dome was documented in all specimens in neutral ankle position, with bending of the ligamentous bands in dorsiflexion. Distraction maneuvers reproducing traction during arthroscopic approaches relieved contact. Conclusions An accessory anteroinferior tibiofibular ligament with distinct anatomical features was recognized. Clinical Relevance Based on its increased incidence in the cadaver ankles, the accessory ligament reflects a normal anatomical finding. Nevertheless, it could lead to anterolateral impingement in cases with coexistent ankle instability.

Anatomy of the tibiofibular syndesmosis and its clinical relevance.

The purpose of the present study was to describe the anatomical structure of the tibiofibular syndesmosis. Dissection of the tibiofibular syndesmosis was performed on 30 cadaveric specimens of the ankle in adults. The stability of the tibiofibular mortise is ensured by three ligaments. The interosseous tibiofibular ligament forms a spatial network of fibers of a pyramidal shape filled with fibrofatty tissue. The anterior tibiofibular ligament consists of three parts: the upper one is the shortest, the medial one is the strongest and the lower part is the longest and the thinnest. The posterior tibiofibular ligament is a strong, compact ligament the lower margin of which literally forms the articular labrum for the lateral ridge of the trochlea of the talus. The so-called inferior transverse tibiofibular ligament, as this part of the ligament is sometimes characterized, cannot be considered as a separate ligament. Direct contact between the distal tibia and the fibula was found in 23 cases. Contact facets which were covered with articular cartilage were very small and located in the anterior half of the tibiofibular contact line. In the posterior part of the tibiofibular contact line a vertical V-shaped synovial plica attached by its lateral aspect to the fibula dipped between the two bones. In seven cases where there was no direct contact between the two bones this plica extended anteriorly to the anterior tibiofibular ligament. The findings show that in three quarters of cases the connection of the distal tibia and fibula is not a mere syndesmosis but also a synovial joint. The presented facts change traditional opinions on the structure of the tibiofibular syndesmosis and they should be reflected in the treatment of dislocation-fractures of the ankle as well as in case of so-called anterolateral ankle impingement.

Imaging of ankle impingement

Although originally described in the 1950s impingement syndromes are now recognised as a significant cause of chronic ankle pain. 1–6 Chronic ankle pain is a common clinical problem and impingement syndromes form a small but significant proportion of this patient group, predominating in athletes and the younger population. Symptoms for all these conditions relate to physical impingement of abnormal osseous or soft tissue resulting in painful limitation of the full range of ankle movement. Anterolateral, anterior and posterior ankle impingement have been extensively described in the orthopaedic literature, with more recent studies describing anteromedial and posteromedial impingement. 1–6 From the radiological view point anterolateral impingement has been the most extensively studied 1,2,7–13 but the potential imaging features involved in the other conditions are now being recognised. This article will deciribe the clinical features, imaging findings and management of ankle impingement.