Combined anterior talofibular ligament (ATFL) lesion and anterolateral syndesmotic impingement after ankle sprain trauma in runners


Syndesmotic impingement ; anterior talofibular ligament ; lateral ankle ligament ; ankle sprain ; arthroscopy.

Published online: Jun 01 2020

Pejman Ziai, Florian Wenzel, Christoph Krall, Alexander Auffarth, Martin Hofstetter, Tomas Buchhorn

From the Orthopädie Zentrum innere Stadt, Vienna, Austria


Anterior inferior tibiofibular ligament (AITFL) lesion have been shown to result in proliferation of cicatricial tissue ; concomitant insufficiency of the anterior talofibular ligament (ATFL) and AITFL Lesion may cause anterolateral syndesmotic impingement in the ankle joint of runners.

Twenty-two runners with suspected syndesmotic impingement after ankle sprain were included in the study. An MRI of the ankle joint was performed followed by arthroscopy.

Arthroscopy revealed an ATFL lesion in 20 patients (87%) and anterolateral syndesmotic impingement in 17 patients (77%). An ATFL lesion was detected in all patients with anterolateral syndesmotic impingement. The sensitivity of MRI was 24% (4 patients) on detecting anterolateral syndesmotic impingement, and 25% (5 patients) on ATFL lesion.

A traumatic sprain of the ankle frequently results in a combined ATFL lesion and anterolateral syndesmotic impingement in runners. The abilities of MRI to detect this combined pathology are limited. Arthroscopy of the ankle joint should be performed.

Study Design : Case series ; level of evidence 4.