SLR - February 2015 - Isin Mustafa

Ankle Syndesmosis: A Qualitative and Quantitative Anatomic Analysis

Reference: Williams BT, Ahrberg AB, Goldsmith MT, Campbell KJ, Shirley L, Wijdicks CA, LaPrade RF, Clanton TO. Ankle Syndesmosis: A Qualitative and Quantitative Anatomic Analysis. Am J Sports Med. 2015 Jan;43(1): 88-97.

Scientific Literature Review

Reviewed By: Isin Mustafa, DPM
Residency Program: Chino Valley Residency Program

Podiatric Relevance: Syndesmotic sprains are often missed and can contribute to chronic pain and instability, often necessitating surgical intervention. A paucity of literature exists detailing the relevant anatomy and landmarks when performing surgical procedures for syndesmotic sprains. The purpose of this article was to qualitatively and quantitatively analyze three syndesmotic ligaments with respect to identifiable landmarks. A thorough understanding of the anatomy can be accomplished by utilizing reproducible data detailing each ligament, thus improving surgical outcomes and reducing complications associated with poor technique.
Methods: Sixteen fresh-frozen human cadavers were utilized to perform this study. Mean age was 59.6 years. Only individuals with no previous history of injury were utilized for dissection. The purpose of the dissection was to identify the three syndesmotic ankle ligaments (AITFL, PITFL, and ITFL) and related bony structures/landmarks. Utilizing related bony landmarks, ligamentous orientation, lengths, and footprints were measured using an anatomically-based coordinate system and a 3-dimensional coordinate device. Heron’s formula was used to calculate ligament footprint areas, and this calculation served as the reference point for each attachment. Averages were calculated using 95% confidence intervals.
Results: The syndesmotic ligaments were found in all 16 specimens. ITFL: originated from the distal interosseous membrane expansion; terminated 9.3mm proximal to the tibial plafond. AITFL: originated from the tibia 9.3mm superior and medial to the anterolateral corner of the tibial plafond; terminated on the fibula 30.5 mm proximal and anterior to the inferior tip of the lateral malleolus. PITFL: originated from the distolateral border of the posterolateral tubercle of the tibia 8.0mm proximal and medial to the posterolateral corner of the tibial plafond; terminated on the medial border of the peroneal groove 26.3mm superior and posterior to the inferior tip of the lateral malleolus.
Conclusion: All three ligaments were identified in all specimens and showed little variation in their origins and insertions. Reproducible data outlining the anatomic attachment sites and distance to bony landmarks can improve surgical intervention for syndesmotic ankle sprains, thereby reducing complications related to poor surgical technique.

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