The PITFL consists of a superficial portion and a deep portion (transverse tibiofibular ligament). The transverse portion creates a posterior labrum of the ankle that deepens the tibiotalar articulation and resists posterior talar translation.
The PITFL superficial portion provides posterior syndesmotic stability. The transverse deep portion creates the posterior ankle labrum, deepening the joint cavity and acting as a check against posterior talar displacement.
PITFL avulsion from the posterior tibial malleolus produces the posterior malleolus fracture. The transverse ligament component can be torn in posterior ankle impingement and is assessed during posterior ankle arthroscopy.
Deep PITFL transverse component impingement or tear producing posterior ankle pain on forced plantarflexion, assessed arthroscopically and released when symptomatic.
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