The anterolateral gutter of the ankle is the synovial recess between the anterior fibula and the anterior talus, lateral to the talar dome. It is the site of anterolateral impingement syndrome, where hypertrophic synovium, meniscoid tissue, or scar from ankle sprain is impinged between the fibula and talus in dorsiflexion.
Anterolateral ankle impingement (Bassett's ligament impingement) is a common cause of persistent pain after lateral ankle sprain. The accessory anteroinferior tibiofibular ligament (Bassett's ligament) or hypertrophic synovium in the anterolateral gutter is pinched between the fibula and talus during dorsiflexion. Ankle arthroscopy via the anterolateral portal directly accesses and debrides this recess. The diagnosis is confirmed by tenderness at the anterolateral ankle joint line and relief with anterolateral portal injection.
Hypertrophic synovium or scar tissue in the anterolateral gutter impinged between the fibula and talus during ankle dorsiflexion, producing anterolateral ankle pain after sprain that fails conservative management, treated by arthroscopic debridement.
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