title: Biomechanical comparison of the interosseous tibiofibular ligament and the anterior tibiofibular ligament.
abstract: BACKGROUND
  The mechanical importance of the interosseous tibiofibular ligament of the ankle is unclear. The purpose of the current study was to compare the stiffness and strength of the interosseous tibiofibular ligament to that of the anterior tibiofibular ligament.
  
  
  METHODS
  Twelve pairs of ankles were obtained from the Maryland State Anatomy Board. All soft tissue was removed except for the interosseous tibiofibular ligament in one ankle of each pair and the anterior tibiofibular ligament in the contralateral ankle. The assignment of which ligament would be excised in the right or left ankle of each pair was random. The specimens were potted as bone-ligament-bone preparations and mounted in a servohydraulic testing machine so that the ligament's long axis was coincident with the actuator. Specimens were elongated at 0.5 mm/s until rupture. Failure load and failure site were recorded, and stiffness was calculated. Stiffness and failure loads were compared with a paired t-test. Significance was set at p < 0.05.
  
  
  RESULTS
  The interosseous ligament was significantly stiffer (234 +/- 122 N/mm) than the anterior tibiofibular ligament (162 +/- 64 N/mm). The mean failure load of the interosseous tibiofibular ligament (822 +/- 298 N) was significantly greater than that of the anterior tibiofibular ligament (625 +/- 255 N).
  
  
  CONCLUSIONS
  The interosseous tibiofibular ligament is stiffer and stronger than the anterior tibiofibular ligament. CLINICAL RELEVANCE. The current study suggests that the interosseous ligament plays an important role in the stability of the ankle, and its status should be part of the diagnostic evaluation in syndesmotic instability.
authors.affiliation: International Center for Orthopaedic Advancement, Department of Orthopaedic Surgery, Johns Hopkins University/Johns Hopkins Bayview Medical Center, Baltimore, MD 21224-2780, USA.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Hoefnagels
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Waites
authors.forename: Ian D
authors.initials: ID
authors.lastname: Wing
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Belkoff
authors.forename: Bart A
authors.initials: BA
authors.lastname: Swierstra
mesh_terms: D000368:Aged; D000843:Ankle Joint / Q000502:physiology*; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000033:anatomy & histology / Q000502:physiology*; D008297:Male; D008953:Models, Anatomic