Chronic instability of the anterior syndesmosis of the ankle: Biomechanical, kinematical, radiological and clinical aspects

This thesis is concerned with chronic anterior instability of the tibiofibular syndesmosis of the ankle. The ankle plays a fundamental role in locomotion. It consists of the talocrural and distal tibiofibular joint. The latter is a syndesmosis, a fibrous joint with ample intervening fibrous connective tissue. The syndesmosis consists of the anterior inferior tibiofibular ligament (ATiFL, also known as the anterior syndesmosis), the interosseous ligament (IL), and the posterior inferior tibiofibular and transverse ligaments (PTiFL and TL), also known as the posterior syndesmosis). Some authors recognize the transverse ligament as a separate entity. Injuries of the tibiofibular syndesmosis can occur in isolation or in combination with osseous or ligamentous ankle injuries. This thesis focuses on syndesmotic injuries without ankle fractures. To stress that no ankle fracture is present they are called ‘isolated syndesmotic injuries’, even though concomitant ligamentous or soft tissue injuries and tibiofibular avulsion fractures may be present. In this thesis the emphasis will be put on chronic anterior syndesmotic instability, but other syndesmotic injuries will be mentioned too.

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