More Than Just the Syndesmosis: Role of Other Ligamentous Stabilizers of the Ankle Mortise

The ligamentous stability of the ankle mortise is largely provided by the syndesmosis, the deltoid ligament, and the lateral ankle ligaments. While injuries to these structures can occur in isolation, combined injury patterns can lead to significant instability and can make treatment challenging. Clinical evaluation requires a variety of tests to thoroughly evaluate instability. Weight-bearing bilateral radiographs are often useful in the evaluation of instability without fracture, while more advanced imaging depends on the clinical situation and resources available. Lateral ankle ligaments, while having an impact on maintaining the tibiotalar contact area, are associated with syndesmotic instability only when combined with an interosseous ligament injury. The deltoid ligament plays a critical, but somewhat controversial role, in syndesmotic instability and treatment. Deltoid repair in the setting of presumed syndesmotic injury remains an area of continued research interest. Level of Evidence: Evidence Level Ⅴ.