Posterior Tibiotalar Ligament Injury Resulting in Posteromedial Impingement

Abstract

Imaging can effectively evaluate the integrity of the PTTL in the context of ongoing posteromedial ankle pain.

Arthroscopic Management of Posteromedial Ankle Impingement

“…The subsequent fibrosis and thickening of the injured posterior tibiotalar ligament and posteromedial capsule cause impingement between the medial wall of the talus and posterior margin of the medial malleolus, resulting in formation of collagenous and fibrous meniscoid lesions and synovitis at the posteromedial ankle. 6,[8][9][10][11][12] The ankle usually shows deep soft-tissue induration and localized tenderness; pain is evocable by palpating the medial retromalleolar area while moving the ankle. 2 Posteromedial tenderness on inversion with the ankle in plantar flexion is an important sign to differentiate the ankle pain originating from the tibialis posterior tendon.…”

Impingement syndromes of the ankle

“…Posteromedial tenderness on inversion with the ankle in plantar flexion is an important clinical finding which differentiates pain originating from primary tibialis posterior abnormality [5]. In a similar manner to posterior impingement symptoms can be insidious or develop subacutely after another injury [5,8,38].…”

“…The exact aetiology and characteristic imaging features of posteromedial impingement have not been as completely defined as other impingement syndromes [5,38,39]. The condition develops after compression of the posteromedial tibiotalar capsule and posterior fibres of the tibiotalar ligament (PTTL) between the talus and medial malleolus during a supination injury [5].…”

Ankle arthroscopy: indication and technique

“…[49,50] Arka ayak yumuşak doku sıkışma sendromu arka talofibuler bağ derin fasikülünün tibial plafondun arka köşesine yapıştığı yerden yırtılması ve derin deltoid bağın yırtılması sonucu oluşur. [51,52] Ayak bileği artroskopisi (ön, arka) ve ard ayak endoskopisi ayak bileği eklemi içi ve çevresi patolojilerinin tedavisinde büyük olanak sunmaktadır. Komplikasyonların büyük oranda portallerle ilgili olması eğitim ve portal anatominin iyi bilinerek dikkatli açılması önem kazanmaktadır.…”