CME OnDemand: 2022 AOFAS Annual Meeting-Role of syndesmotic ligaments in lateral ankle instability

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This study aimed to assess the effect of syndesmotic ligament injury on the stability of the lateral ankle. The researchers evaluated 24 cadaveric specimens divided into three groups. Group 1 had the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL) transected. Group 2 had additional transections of the anterior inferior tibiofibular ligament (AITFL), interosseous ligament (IOL), and PITFL, along with the ATFL, CFL, and PTFL. Group 3 had the AITFL, ATFL, CFL, IOL, PTFL, and PITFL transected.<br /><br />The results showed that in Group 1, the lateral ankle remained stable after transection of the ATFL, but became unstable after additional transection of the CFL. In Group 2, the lateral ankle remained stable even after all syndesmotic ligament transections, but became unstable after additional transection of the ATFL. In Group 3, transection of the ATFL and AITFL resulted in lateral ankle instability, which worsened with further transection of the CFL and PTFL.<br /><br />The researchers concluded that isolated syndesmotic disruption did not result in lateral ankle instability. However, when combined with ATFL disruption, lateral ankle instability occurred. It was recommended that clinicians maintain a lower threshold for operative intervention for syndesmotic stabilization if there are residual symptoms over the AITFL.<br /><br />Overall, this study suggests that the syndesmotic ligaments contribute to lateral ankle stability when combined with ATFL disruption. These findings provide insights into the role of syndesmotic ligaments in lateral ankle instability and can guide clinical decision-making in cases of concomitant lateral ankle and syndesmotic ligament injuries.

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Rohan Bhimani, MD, MBA, Go Sato, MD, Jirawat Saengsin, MD, Bart Lubberts, MD, PhD, Gregory Waryasz, MD, Christopher W. DiGiovanni, MD, Daniel Guss, MD, MBA

Keywords

syndesmotic ligament injury

stability

lateral ankle

cadaveric specimens

ligament transection

ATFL

CFL

PTFL

AITFL

IOL