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Jorge de-las-Heras Romero Department of Orthopaedics and Traumatology, University General Hospital Reina Sofía, Avda Intendente Jorge Palacios 1, Murcia 30003, Spain

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Ana María Lledó Alvarez Regional Statistical Center, Treasury and public administration council, Murcia, Spain

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Fernando Moreno Sanchez Department of Orthopaedics and Traumatology, University General Hospital Reina Sofía, Murcia, Spain

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Alejandro Perez Garcia Department of Orthopaedics and Traumatology, University General Hospital Reina Sofía, Murcia, Spain

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Pedro Antonio Garcia Porcel Department of Orthopaedics and Traumatology, University General Hospital Reina Sofía, Murcia, Spain

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Raul Valverde Sarabia Department of Orthopaedics and Traumatology, University General Hospital Reina Sofía, Murcia, Spain

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Marina Hernandez Torralba Department of Orthopaedics and Traumatology, University General Hospital Reina Sofía, Murcia, Spain

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Introduction The term syndesmotic injury is used to describe a lesion of the ligaments that connect the distal fibula and the tibial notch surrounded on both sides by the anterior and posterior tibial tubercles, with or without an associated

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Ulrike Wittig Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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Gloria Hohenberger Department of Trauma, LKH Feldbach-Fürstenfeld, Feldbach, Austria

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Martin Ornig Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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Reinhard Schuh Department of Orthopaedics, Protestant Hospital Vienna, Vienna, Austria

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Andreas Leithner Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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Patrick Holweg Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria

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Introduction Lateral ankle sprains are among the most common injuries in sports ( 1 , 2 , 3 ). The anterior talofibular ligament (ATFL) is the most frequently injured ligament, followed by the calcaneofibular ligament (CFL) ( 4 , 5 , 6

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Nuno Corte-Real Department of Orthopaedics, Hospital de Cascais Dr. José de Almeida, Portugal

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João Caetano Department of Orthopaedics, Hospital de Cascais Dr. José de Almeida, Portugal

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complications. The term instability implies a dysfunction of the ligaments. It can be acute or chronic and results from a traumatic event, and is therefore related with a ligament rupture. The ankle has three main set of ligaments: the lateral, the medial and

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F T Spindler Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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V Herterich Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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B M Holzapfel Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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W Böcker Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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H Polzer Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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S F Baumbach Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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( 4 ). However, assessing syndesmotic stability remains a challenge. The syndesmotic complex comprises three major ligaments: the anterior inferior tibiofibular ligament (AiTFL), the interosseous membrane (IOM), and the posterior inferior

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Nicola Krähenbühl Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland

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Tamara Horn-Lang Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland

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Beat Hintermann Cantonal Hospital Baselland, Rheinstrasse 26, 4410 Liestal, Switzerland

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Markus Knupp Mein Fusszentrum, Eichenstrasse 31, 4054 Basel, Switzerland

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‘spring’ ligament. This ligament complex plays a key role in stabilising the talar head. Insufficiency of this structure can lead to acquired flat foot deformity. Posteriorly, the concave facet of the talus lies on the convex posterior facet of the

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Fabian Tobias Spindler Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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Wolfgang Böcker Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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Hans Polzer Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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Sebastian Felix Baumbach Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany

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high-impact sports ( 5 ). Consequently, orthopedic surgeons are frequently encountered with syndesmotic injuries and must rate their stability. The syndesmotic complex comprises of three major ligaments, the anterior–inferior tibiofibular ligament

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Kinner Davda Department of Foot & Ankle Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK

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Karan Malhotra Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK

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Paul O’Donnell Department of Foot & Ankle Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK

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Dishan Singh Department of Foot & Ankle Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK

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Nicholas Cullen Department of Foot & Ankle Surgery, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK

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Introduction Pathological abnormality of the peroneal tendons is an under-appreciated source of lateral hindfoot pain and dysfunction that can be difficult to distinguish from lateral ankle ligament injuries. In a study by Dombek et al, 1

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Haroon Majeed Wrightington Hospital, UK

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Donald J. McBride The Royal Stoke University Hospital, UK

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maintaining the ankle mortise. It forms the lateral portion of the subtalar joint articulating with the posterior facet of the calcaneum inferomedially. The lateral talocalcaneal ligament originates from the tip of this process. 5 Incidence Despite

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Omar A. Al-Mohrej King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia

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Nader S. Al-Kenani King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia

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Introduction Among musculoskeletal injuries, the incidence of ankle sprains is between 15% and 20% of sports injuries. 1 , 2 The ankle is supported laterally by the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL) and

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José Nuno Ferreira Department of Orthopaedics, Hospital Beatriz Ângelo, Portugal

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João Vide Department of Orthopaedics, Hospital Beatriz Ângelo, Portugal

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Daniel Mendes Department of Orthopaedics, Hospital Beatriz Ângelo, Portugal

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João Protásio Department of Orthopaedics, Hospital Beatriz Ângelo, Portugal

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Rui Viegas Department of Orthopaedics, Hospital Beatriz Ângelo, Portugal

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Manuel Resende Sousa Department of Orthopaedics, Hospital da Luz, Portugal

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. 6 The most commonly affected ligament is the anterior talofibular ligament (ATFL), which is the weakest of the three lateral ankle ligaments, followed by injury of the calcaneofibular ligament (CFL) and the posterior talofibular ligament (PTFL

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