Purpose: The anterior tibiofibular ligament (ATiFL) and its distal fascicle have been the subject of numerous studies, mainly due to the involvement of this ligament in anterolateral soft-tissue impingement of the ankle. There is currently no firm evidence related to the incidence of the distal fascicle or the frequency with which it is in contact with the talus, or whether this is a constant anatomic finding. In addition, the terminology used to refer to this structure is not accurate and varies widely in previous studies. The purpose of this study was to perform an anatomic study on a large number of specimens to clarify the anatomy of the anterior tibiofibular ligament, and specifically its distal fascicle, and its possible role in anterior ankle impingement syndrome.
Methods: During a 7-year period (2010-2016), cadaveric ankle specimens dissected at our Anatomy Department were included in this study, accounting for a total of 154 ankles. The incidence of the distal fascicle and its contact with the talus were documented.
Results: One hundred and seventeen ankles were included [78 men, 39 women, with a median age of 79.3 years (range 51-100 years)]. The ATiFL was found to have a distal fascicle in 100% of ankles, contacting the anterolateral part of the talus in all cases. The contact was increased in plantarflexion and reduced in dorsiflexion and finally disappeared completely in maximum dorsiflexion.
Conclusions: The ATiFL has a constant distal fascicle that is in contact with the talus in the neutral position and in plantar flexion. Contact disappears in maximum dorsiflexion.
Keywords: Anatomy; Ankle joint; Ankle lateral ligament; Ankle soft-tissue impingement; Arthroscopy; Tibiofibular syndesmosis.