Intermalleolar Ligament Research Articles

Ligaments of the ankle: normal anatomy with MR arthrography.

Our purpose was to define the normal MR arthrographic anatomy of ankle ligaments. Prior to injection of intraarticular gadolinium in cadaveric ankle joints, proton density and T2-weighted images were obtained to assess the integrity of the ligaments and tendons as well as the amount of preexisting joint effusion. Following injection of 10 ml of contrast agent (gadopentetate dimeglumine 1:250, Omnipaqe 300, Knox gelatin 50%, and methylene blue), T1-weighted images with fat saturation in axial, oblique axial, coronal, and sagittal planes were obtained in neutral, dorsiflexion, and plantar flexion positions. Specimens were sectioned, allowing anatomic and MR correlation. Contrast agent outlining anterior and posterior aspects of the anterior talofibular ligament and posterior talofibular ligament (PTAF) was a normal finding, related to anterior and posterior recesses of the ankle joint that extend out beyond these ligaments in an anteroposterior direction above the level of the ligaments. Intraarticular contrast material allowed resolution of superficial and deep components of the posterior tibiofibular ligament. Both were seen separately from PTAF with dorsiflexion. Posterior intermalleolar ligament was not present in our specimens. Visualization of calcaneofibular ligament was much improved by contrast material outlining the articular aspect of the ligament. Visualization of the syndesmotic ligamentous complex also was improved by contrast material outlining the articular side of the ligaments and separating them from adjacent bone. Superiorly, the distribution of contrast agent was limited by the interosseous ligament. Visualization of the medial collateral ligaments was not improved by the presence of the intraarticular contrast material. MR arthrography of the ankle allows improved visualization and evaluation of the lateral and syndesmotic ligamentous complex.

Posterior intermalleolar ligament of the ankle: normal anatomy and MR imaging features.

The purposes of this study were to delineate the normal anatomy and MR imaging features of the posterior intermalleolar ligament--a normal ligamentous variant of the posterior portion of the ankle--and to identify normal anatomic characteristics that may account for the role of the ligament in the development of posterior impingement syndrome. The prevalence, size, and shape of the posterior intermalleolar ligament were documented in 36 cadaveric ankles and in 97 MR studies of the ankle in patients with and without symptoms. The posterior intermalleolar ligament was identified in 20 (56%) of the 36 cadaveric feet. It was 1-8 mm wide, and its diameter (anterior to posterior) was 5-8 mm. The ligament often resembled a meniscus, and in one case its anterior lip herniated into the ankle joint. The posterior intermalleolar ligament was detected in 18 (19%) of the 97 MR studies of the ankle. It was visualized on coronal T1- or T2-weighted images as a distinct, hypointense band traversing between the posterior talofibular ligament and the inferior transverse ligament. The posterior intermalleolar ligament is a normal variant of the posterior ligaments of the ankle and is present in a significant number of persons. It is best seen on coronal T1- and T2-weighted MR images. Its meniscuslike shape and occasional extension into the ankle joint may account for the development of posterior impingement syndrome in susceptible persons.