Tibiofibular syndesmosis lesions : It’s important to know ? And should we treat?

Tibiofibular syndesmosis lesions are common injuries associated with ankle sprains and fractures. These injuries are often overlooked or underestimated, leading to long-term complications such as rotational instability and ankle osteoarthritis. The complex anatomy of ankle ligaments includes the lateral ligament group, deltoid ligament, and syndesmosis, each consisting of multiple components. Syndesmosis lesions typically occur in conjunction with malleolar fractures, particularly in cases of pronation external rotation or supination external rotation. Clinical examination involves assessing the patient's history, examining for specific signs such as edema and pain over the anterior inferior tibiofibular ligament, and performing stress tests to provoke pain in the syndesmosis. Ankle X-rays, including weight-bearing views, can provide valuable information, although their diagnostic accuracy is limited. CT scans are useful for measuring inter-tibiofibular gaps and assessing fibular translation and rotation. MRI is a valuable diagnostic tool but may not be universally available. The treatment of these lesions remains controversial, with no established consensus. This work tries to give an overview of the latest search on this topic.