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The anterior tibiofibular ligament has a constant distal fascicle that contacts the anterolateral part of the talus



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.


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.


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.


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.

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  1. 1.

    Bassett FH, Gates HS, Billys JB, Morris HB, Nikolaou PK (1990) Talar impingement by the anteroinferior tibiofibular ligament. A cause of chronic pain in the ankle after inversion sprain. J Bone Jt Surg Am 72:55–59

  2. 2.

    Van Den Bekerom MPJ, Raven EEJ (2007) The distal fascicle of the anterior inferior tibiofibular ligament as a cause of tibiotalar impingement syndrome: a current concepts review. Knee Surg Sport Traumatol Arthrosc 15:465–471

  3. 3.

    Nikolopoulos C (1982) Anterolateral instability of the ankle joint: an anatomical, experimental, and clinical study. Ph.D. Thesis, University of Athens

  4. 4.

    Nikolopoulos CE (2004) The accessory anteroinferior tibiofibular ligament as a cause of talar impingement: a cadaveric study. Am J Sports Med 32:389–395

  5. 5.

    Subhas N, Vinson EN, Cothran RL, Santangelo JR, Nunley JA, Helms CA (2008) MRI appearance of surgically proven abnormal accessory anterior-inferior tibiofibular ligament (Bassett’s ligament). Skelet Radiol 37:27–33

  6. 6.

    Yeo ED, Rhyu IJ, Kim HJ, Kim DS, Ahn JH, Lee YK (2016) Can Bassett’s ligament be removed? Knee Surg Sport Traumatol Arthrosc 24(4):1236–1242

  7. 7.

    Akseki D, Pinar H, Bozkurt M, Yaldiz K, Araç S (1999) The distal fascicle of the anterior inferior tibio-fibular ligament as a cause of anterolateral ankle impingement. Acta Orthop Scand 70:478–482

  8. 8.

    Akseki D, Pinar H, Yaldiz K, Akseki NG, Arman C (2002) The anterior inferior tibiofibular ligament and talar impingement: a cadaveric study. KSSTA 10:321–326

  9. 9.

    Bartoníček J (2003) Anatomy of the tibiofibular syndesmosis and its clinical relevance. Surg Radiol Anat 25:379–386

  10. 10.

    Boonthathip M, Chen L, Trudell DJ, Resnick DL (2010) Tibiofibular syndesmotic ligaments: MR arthrography in cadavers with anatomic correlation. Radiology 254:827–836

  11. 11.

    Ebraheim NA, Taser F, Shafiq Q, Yeasting RA (2006) Anatomical evaluation and clinical importance of the tibiofibular syndesmosis ligaments. Surg Radiol Anat 28:142–149

  12. 12.

    Ray RG, Kriz BM (1991) Anterior inferior tibiofibular ligament. Variations and relationship to the talus. J Am Podiatr Med Assoc 81:479–485

  13. 13.

    Hermans JJ, Beumer A, De Jong TAW, Kleinrensink GJ (2010) Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach. J Anat 217:633–645

  14. 14.

    Jacobson K, Ng A, Haffner KE (2011) Arthroscopic treatment of anterior ankle impingement. Clin Podiatr Med Surg 28:491–510

  15. 15.

    Dalmau-Pastor M, Vega J (2017) Letter regarding: cadaveric analysis of the distal tibiofibular syndesmosis. Foot Ankle Int 38:343–345

  16. 16.

    Federative Committee on Anatomical Terminology (1998) International Anatomical Terminology. Thieme, Stuttgart

  17. 17.

    Golanó P, Vega J, Pérez-Carro L, Götzens V (2006) Ankle anatomy for the arthroscopist. Part II: role of the ankle ligaments in soft tissue impingement. Foot Ankle Clin 11:275–296

  18. 18.

    Vega J, Dalmau-Pastor M, Malagelada F, Fargues-Polo B, Peña F (2017) Ankle arthroscopy: an update. J Bone Jt Surg 99:1395–1407

  19. 19.

    Rasmussen O, Tovborg-Jensen IB, Boe S (1982) Distal tibiofibular ligaments. Acta Orthop Scand 53:681–686

  20. 20.

    Caputo AM, Lee JY, Spritzer CE, Easley ME, Deorio JK, Ii JAN, Defrate LE, Carolina N (2009) In vivo kinematics of the tibiotalar joint after lateral ankle instability. Am J Sports Med 37:2241–2248

  21. 21.

    Vega J, Peña F, Golanó P (2016) Minor or occult ankle instability as a cause of anterolateral pain after ankle sprain. Knee Surg Sport Traumatol Arthrosc 24(4):1116–1123

  22. 22.

    Katz JN, Barrett J, Mahomed NN, Baron JA, Wright RJ, Losina E (2004) Association between hospital and surgeon procedure volume and the outcomes of total knee replacement. J Bone Jt Surg Am 86–A:1909–1916

  23. 23.

    Lau RL, Perruccio AV, Gandhi R, Mahomed NN (2012) The role of surgeon volume on patient outcome in total knee arthroplasty: a systematic review of the literature. BMC Musculoskelet Disord 13:250

  24. 24.

    McAteer JP, LaRiviere CA, Drugas GT, Abdullah F, Oldham KT, Goldin AB (2013) Influence of surgeon experience, hospital volume, and specialty designation on outcomes in pediatric surgery. JAMA Pediatr 167:468–475

  25. 25.

    Pennington N, Redmond A, Stewart T, Stone M (2014) The impact of surgeon handedness in total hip replacement. Ann R Coll Surg Engl 96:437–441

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Correspondence to Miki Dalmau-Pastor.

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We declare that we have no conflicts of interest in the authorship or publication of this contribution.

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Ethical approval statement was provided by the University of Barcelona with Institutional Review Board IRB00003099.

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Dalmau-Pastor, M., Malagelada, F., Kerkhoffs, G.M.M.J. et al. The anterior tibiofibular ligament has a constant distal fascicle that contacts the anterolateral part of the talus. Knee Surg Sports Traumatol Arthrosc 28, 48–54 (2020). https://doi.org/10.1007/s00167-018-5123-z

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  • Anatomy
  • Ankle joint
  • Arthroscopy
  • Ankle lateral ligament
  • Tibiofibular syndesmosis
  • Ankle soft-tissue impingement