What Is the Anterior Tibiofibular Ligament?

Ankle ligament injuries are divided into two types: partial and complete rupture. The former is called ankle sprain or sting, and the latter can cause dislocation or subluxation of the ankle. When the ligament of the triangle, all the ligaments of the lower tibiofibular fibula, or part of the interosseous membrane are injured at the same time, the lower tibiofibular separation and the talus dislocation can occur. Clinically, the anterior peroneal ligament injury of the lateral malleolus and the anterior tibiofibular ligament injury are more common. The triangular ligament injury is often associated with ankle fracture and dislocation.

Basic Information

Visiting department: orthopedics
Common locations: ankle joint

Common causes: Direct violence, indirect violence, and muscle strain
Common symptoms: Local tenderness, subcutaneous ecchymosis, limited joint movement, etc.

Causes of ankle ligament injury

Direct violence, indirect violence, and muscle strain can all cause injuries.

Clinical manifestations of ankle ligament injury

1. Ankle ligament injury

The fibula head of the lateral malleolus is about 1cm longer than the medial malleolus. When the ankle is sprained, it is easy to cause varus injury. In addition, the lateral ligament is relatively weak, so lateral ligament injuries are more common clinically. The lateral malleolus ligament includes anterior fibula ligament, fibula ligament, and posterior fibula ligament. At the moment of trauma, the flexion and extension of the visual foot are different, and the three groups of ligaments are also affected. For example, the anterior fibula ligament injury is more common in plantar flexion, and the posterior fibula ligament injury is more common in dorsiflexion, and it is more common in the medial position.

(1) When the anterior fibula ligament foot is under normal load, the anterior fibula ligament is aligned with the long axis of the talus; when the ankle is plantar flexion, its traveling direction is consistent with the longitudinal axis of the tibia and becomes tense. During overturning stress, the anterior fibula ligament tears and completely breaks.

(2) Fibular Achilles Ligament When the ankle joint is in plantar flexion, if the varus stress is further increased, in addition to the anterior fibula ligament injury, the fibular ligament can also be damaged. If the ankle joint is in the neutral position, when the ankle joint is extremely inverted, the fibular ligament injury can be caused first. The fibular calcaneal ligament is the main structure of the lateral malleolus ligament. When the ankle joint is functional, it has the effect of limiting foot varus. Therefore, once it breaks, the lateral space of the ankle joint widens.

(3) The posterior peroneal ligament is the strongest bundle of the lateral malleolus ligament, which mainly restricts excessive back extension of the ankle joint. The posterior peroneal ligament injury is mainly caused by foot overrun inversion.

2. Medial malleolus ligament injury

In most cases, the medial malleolus injury is caused by valgus or external rotation violence. This external force usually causes fractures of the medial malleolus and / or lateral malleolus. But if the violence comes very suddenly, it can also cause the triangular ligament to rupture. Among them, simple ligament rupture is rare, and it is complicated by lateral malleolus fracture and / or inferior tibiofibular joint separation.

3. Inferior tibiofibular ligament injury

Inferior tibiofibular ligament injury is mainly caused by valgus and external rotation violence. It is not rare in clinical practice, but it is easy to miss diagnosis. Injury of the lower tibiofibular ligament with triangular ligament rupture (with or without lateral malleolus fracture) is generally caused by the triangular ligament breaking first, so that the tensile stress of the lower tibiofibular ligament suddenly increases, and once it exceeds its maximum, it will cause rupture.

4. Acute ligament injury of the ankle

Most have a clear history of trauma. Clinically, the patient can find swelling and pain in the front and bottom of the lateral malleolus, local tenderness, subcutaneous bruising, limited joint movement, and claudication. Pain worsens with passive plantar flexion and varus, while pain is reduced with extensor and eversion. When the ankle joint is completely broken, the talus can be moved forward. In addition to medial malleolus ligament injury, in addition to pain, swelling, subcutaneous congestion, bruising, and restricted foot movement in the submedial malleolus area, swelling and congestion can be found in the ankle canal behind the medial malleolus. The symptoms of the lower tibiofibular ligament injury are similar to the above, but the pain and swelling are in front of the ankle joint and not on the side.

5. Signs of lateral malleolus ligament injury

Examination of local tenderness is most obvious at the inferior malleolus ligament, which is more localized and easily distinguished from lateral malleolus fractures. The medial malleolus ligament injury and tenderness are mostly at the attachment of the lower medial malleolus ligament. The lower tibiofibular ligament injury is tender in front of the ankle joint.

The ligament injured by passive inversion of the foot is stretched and the pain is aggravated. Forcibly invaded foot, the depression of the lateral malleolus ligament rupture increases; the medial malleolus is damaged, the pain of the forced valgus foot is aggravated and the ligament rupture may appear, and the lower leg is fixed Pushing the heel may increase the medial range of motion; when the lower tibiofibular ligament is injured, hold the heel for lateral or rotational movement of the talus, and you can find that the range of talar motion increases.

Ankle Acute Ligament Injury Examination

Ankle puncture imaging can find that the contrast agent enters the fractured ligament injury from the ankle joint. MRI has good soft tissue resolution, can determine the range of injured hematomas in the soft tissue of the ankle, and can identify tears, breaks, and injuries of ligaments.

Diagnosis of acute ligament injury of ankle

A clear history of trauma, X-ray examination and stress radiographs can indirectly confirm the presence of ligament damage. In addition, ankle arthroplasty can also indirectly confirm the existence of injury. MRI can determine the extent of hematoma, identify the existence and extent of ligament tear, rupture injury.

Ankle Ligament Injury Treatment

Non-surgical treatment

(1) Incomplete rupture of the lateral malleolus ligament In addition to general treatments such as early local cold compresses, the affected foot should be strictly braked to facilitate ligament repair. Incomplete injury of the anterior fibula ligament: Fix the valgus and dorsal extension with calf plaster for 3 to 4 weeks. After removing the plaster, use ankle brace and functional exercise. Incomplete rupture of peroneal ligament: functional position of ankle joint (90 100 °), valgus calf plaster fixation for about 4 weeks, follow-up treatment is the same as before. Incomplete injury of the posterior peroneal ligament: The calf plaster is valgus and the plantar flexion is fixed for 4 to 5 weeks.

(2) Incomplete injury of the simple triangular ligament in the medial malleolus ligament injury is usually fixed with the calf plaster inversion for 4 to 5 weeks. Mild patients can also be fixed with wide adhesive tape for 3 weeks, and then physiotherapy and external ankle protection can be applied after the fixation.

(3) Calf casts of the lower tibiofibular ligament are treated with calf plaster, and pressurized on both sides of the ankle joint (pressurized with bilateral palms) to restore it. Replace the external ankle brace after 4-6 weeks of fixation.

2. Surgical treatment

(1) Except for those who cannot perform surgery due to poor systemic conditions, ligament repair should be performed in principle. For advanced cases with difficult repair, part or all of the nearby short peroneus muscles can also be used to reconstruct the damaged ligaments.

(2) The complete fracture of the triangular ligament with fracture is repaired for the fractured ligament. For fractures with displacement, open reduction plus internal fixation (mostly tension band or screw fixation) can be performed at the same time. After surgery, the calf was cast for 4 to 5 weeks. Perform functional exercises and external ankle brace after removing plaster.

(3) Triangular ligament rupture (manufactured with lateral malleolus fracture) with detachment of the lower tibiofibular joint concurrently with the operation. At the same time, the lower tibiofibular joint is fixed with a long screw. The fixation time is generally not more than 6 weeks.

(4) Injury of the lower tibiofibular ligament with concurrent displacement fractures. While open reduction and internal fixation of the fracture, long screw compression fixation and reduction are usually used. Postoperative plaster braking is performed for 6 to 8 weeks, and according to the fracture healing status. Decide on plaster removal time.