0:00

I'm in the back of the ankle

0:02

now, looking at collaterals.

0:03

A very tough projection to assess

0:06

these ligaments, which, by the way,

0:08

don't usually tear with acute injuries.

0:11

More common to be impinged upon in plantar

0:15

flexures with posterior impingement

0:16

syndrome, especially ballet dancers.

0:19

Let's have a look, and we'll start up high.

0:22

So, you'll notice I'm not over at the fibular tip.

0:25

I'm inside the fibular tip

0:26

between it and the tibia.

0:28

So there's, there's the tibia.

0:30

And let's pick up this ligament right here.

0:32

Which is the posterior tib fib ligament.

0:35

Sometimes it's confused for

0:36

a mass because it's so dark.

0:39

Now let's follow it.

0:41

Let's follow it, uh, a little more laterally.

0:45

And as we do, I think you can see

0:47

it a little better right there.

0:49

The anterior component of it,

0:51

here, is the inferior transverse

0:55

ligament of the tib fib syndesmosis.

0:57

So there's a back portion, the tib fib ligament.

1:00

And the inferior tib fib component,

1:04

which is part of the crural system.

1:07

Then, we have the intermalleolar ligament,

1:11

which courses obliquely between malleoli.

1:14

It also is sometimes confused for a mass if it's

1:17

seen as a round structure, but its linearity

1:20

is very apparent on the T1-weighted image and

1:23

on the proton density fat suppression image.

1:26

So, so far I've shown you the two

1:28

components of the high ankle tib fib.

1:32

The posterior tib fib and the inferior

1:35

transverse ligament of the tib fib.

1:39

The intermalleolar ligament.

1:40

And then finally down here we have these two

1:42

structures that are going to merge together to

1:45

form the low ankle posterior talofibular ligament.

1:49

Now that one too, especially as you approach

1:52

the midline, is often confused, especially

1:55

when there's an effusion around it.

1:56

No, that is simply the

2:00

posterior talofibular ligament.

2:02

Now, some of you are wondering, well,

2:04

where is the calcaneofibular ligament?

2:06

It's so small, and it's curving at

2:10

such an obliquity to the sagittal

2:12

projection that you can't see it.

2:14

You see one tiny smidgen of it.

2:16

I'm going to blow it up right here.

2:18

You can see an origin of it, and that's it.

2:21

That tiny little structure is the

2:23

origin of the calcaneofibular ligament.

2:26

So, the sagittal projection, more

2:28

importantly, is a source of confusion,

2:31

sometimes producing the confusing picture

2:34

of the ligaments looking like bodies, when

2:37

in fact they're simply normal structures.

2:39

And you can follow them back and forth, medial to

2:42

lateral, across the ankle, and then once you learn

2:44

the order of them, things become a lot easier.