Ankle syndesmosis: a qualitative and quantitative anatomic analysis

Area of Science:

• Orthopedic surgery
• Anatomy
• Biomechanics

Background:

• Syndesmosis sprains often require surgical intervention due to chronic pain and instability.
• Current surgical techniques lack detailed objective anatomical data for precise execution.
• Understanding osseous landmarks is crucial for effective syndesmotic injury repair.

Purpose of the Study:

• To quantitatively and qualitatively analyze the anatomy of the three syndesmotic ligaments.
• To define ligamentous anatomy in relation to surgically identifiable bony landmarks.
• To provide data for optimizing surgical fixation and reconstruction.

Main Methods:

• Descriptive laboratory study involving dissection of sixteen ankle specimens.
• Identification and measurement of the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), and interosseous tibiofibular ligament (ITFL).
• Utilized a 3D coordinate measuring device and an anatomically based coordinate system for precise measurements relative to bony landmarks.

Main Results:

• Detailed measurements of ligament lengths, footprints, and orientations were obtained for all syndesmotic ligaments.
• The interosseous tibiofibular ligament (ITFL) was identified as pyramidal and the broadest.
• Specific distances from ligament origins and insertions to key bony landmarks (e.g., tibial plafond, lateral malleolus) were recorded.

Conclusions:

• The study successfully provided reproducible qualitative and quantitative anatomical descriptions of syndesmotic ligaments.
• The data precisely define ligamentous anatomy with respect to surgically identifiable bony prominences.
• This anatomical data is vital for enhancing surgical fixation techniques, improving anatomic restoration, and reducing iatrogenic risks.