Syndesmosis

[Son Nguyen]

Hi Birdies!

Patient came in today. Soccer player injured his ankle on the weekend. Jumped for a header and landed on someone’s foot rolling his ankle. His history included an old ATFL tear years ago. He localised his pain to the high ankle region, and I thought you beauty syndesmosis here we go.

He had a normal plain x-ray. On ultrasound a moderate ankle joint effusion, ATFL torn as previously noted, but an intact AITFL. Superior to AITFL it was oedemas, with some joint widening on stress. Patient’s pain was located right on this. I read in literature the AITFL can be made of of more than one ligament or an accessory ligament. Could this be a ligament tear or is it part of the interosseous membrane. Or am I missing something else?

Thanks in advance!

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[Son Nguyen]

Or interosseous ligament

[Stephen Bird]

Nice one,

I think you are spot on,

The primary AITFS looks intact in the lower portion, however in the proximal portion it is split down the middle and you can see some fat herniating through the defect,

The AITFS is called a syndesmosis as it is a broad flat collagen sheet and I think you have seen a split involving the proximal part of it and preservation of the distal part.

If you like it is a partial width tear of the AITFS,

There is a concept of the Bassett’s ligament which is the distal end of the AITFS so you could also say this is a tear of the AITFS with preservation of the Bassett’s ligament component.

Steve

Nice one.

[Author]

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