The interosseous tibiofibular ligament is the short, stout ligament between the fibular notch of the tibia and the medial fibula, forming the deep layer of the syndesmosis above the inferior transverse ligament. It is the strongest of the syndesmotic ligaments and is the last to fail in complete diastasis.
The deepest and strongest syndesmotic stabiliser; provides the primary resistance to tibiofibular diastasis and fibular rotation.
The interosseous tibiofibular ligament is evaluated on coronal MRI as a triangular low-signal structure in the fibular notch. Its complete disruption indicates a high-grade syndesmotic injury requiring surgical stabilisation. It must be distinguished from the distal portion of the interosseous membrane, which it is continuous with. Isolated injury to this ligament without AITFL damage is uncommon.
Full-thickness tearing of the interosseous tibiofibular ligament combined with AITFL and PITFL injury producing unstable tibiofibular diastasis requiring syndesmotic screw or suture-button fixation.
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