distal fascicle of the anterior inferior tibio-fibular ligament in correlation with talar impingement

ABSTRACT

Up till now, the anterior inferior tibiofibular ligament [AITFL] is described in the anatomic tradition as one entity. The present investigation confirmed the presence of what was recently termed [a distal fascicle] of the ligament, which appeared as a separate band found in all [thirteen] the examined cadavers. It took the shape of a parallelogram that lied below and parallel to the rest of the AITFL. A pad of fat separated this fascicle from the rest of the ligament that masked its easy differentiation for a long time. In extreme dorsiflexion of the ankle, the lower border of the fascicle became tight and touched the dome of talus. Also, the clinical study showed audible popping and friction between the thickened fascicle and the opposite hyaline cartilage on talus. This indicated a ligamentous talar impingement with chronic pain on the anterolateral aspect of the ankle in 5 out of 9 patients with soft tissue talar impingement syndrome related to the anterolateral compartment of the ankle. Arthroscopic resection of the distal fascicle gave excellent results with complete relief of pain in all 5 patients suffering of this lesion. Arthroscopic removal of this fascicle along with treatment of other offending pathological lesions gave excellent results in 8 out of 9 patients after an average follow up of 13 months. It was concluded that the anatomy of this distal fascicle has to be included in literature. Furthermore, its pathologic role in talar impingement should be appreciated, yet not overemphasized by clinicians and those dealing with sport injuries, especially when exostoses are absent in radiographs