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Now let's begin our, uh, story of anatomy.

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Looking at some of these ligament disc complexes,

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of which there are three, we're gonna start

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with a lateral ligament disc complex.

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Some call this the low lateral ligament disc complex.

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They're separated from the syndesmotic complex.

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There are three ligaments here,

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the anterior talo fibrile ligament,

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the posterior ta fibrile ligament,

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and the calcan fibrile ligament.

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And there are some differences with regard

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to their general anatomy.

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The anterior and posterior talo fibrile ligaments are short

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ligaments as opposed to the calcan fibrile ligament,

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which is a long ligament.

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These ligaments are capsular ligaments

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that will become important a little bit later.

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The calcan fibrile ligament is an extra capsular ligament,

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much like the fibular collateral ligament of the knee.

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In addition, and perhaps very important for you

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to know is these two ligaments,

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the capsule ligaments are related only to a single joint.

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And that joint is the ankle joint.

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The calcan fibrile ligament relates to two joints,

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the ankle, and then also the posterior subular joint.

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This will become important later on when we deal

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with examples of isolated tearing

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of the calcaneal fibrile ligament.

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Alright, I'm adding to this diagram now two of the

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syndesmotic ligaments, the anterior tibial fibrile ligament

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and the posterior tibial fibrile ligament.

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We're gonna talk more about those in a moment,

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but let's do something now.

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The experiment of dividing this particular lateral region

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into those ligaments that are low lateral ligaments

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and those ligaments that are high lateral ligaments.

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And the reason I do that is

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because of the entity known as a high ankle sprain.

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High ankle sprains generally relate to abnormalities

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of the syndesmotic ligaments.

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Okay? Of which there are four,

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I'm just showing you two at this moment.

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The difficulty with that particular term, high ankle sprain,

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it may occur as an isolated phenomenon,

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but it also may be associated with a low medial problem

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with the deltoid ligament.

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So keep in mind,

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although we may call this a high ankle sprain,

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and there may be problems low down on the medial side

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to give you an idea of the complexity of these ligaments.

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Okay. I wanted to show you a view as if you were the back

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of a shoe looking forward.

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And as we look forward, we see portions

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of the ankle joint here and the posterior subular joint.

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Here we can recognize the lateral ligament, the

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Posterior talo fibrile ligament here,

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and we can see portions of the calcan fibrile ligament.

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Here is another ligament, a tibial slip intimate

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with a posterior talo fibrile ligament.

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And then we can see two of the

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syndesmotic ligaments, the inferior transverse ligament,

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the lowest of the syndesmotic ligaments,

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and above it, the posterior tibial fibular ligament.

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Now let's look at these lateral ligaments in more detail.

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The posterior talo fib ligament is shown here

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with its attachment on the fibula with the white arrows,

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and its coarse with the uh, arrows.

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It is typically striated, it may have areas

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of fat within it.

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It attaches the lateral tubercle, uh, uh,

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or attaches the lateral tubercle, trium trigonal process

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or trigonum of the Alis with the fibula.

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So that is the course of it. It is a capsular ligament.

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It is almost horizontal

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or horizontal oblique, so you may see it, uh,

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almost in a single image

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or certainly in two consecutive axial images.

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The anterior talo fbri ligament is also a short capsule

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ligament running from the fibula to the adjacent, uh,

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ALIS as shown here.

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Alright, this is an important ligament

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and one that is often torn.

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And I wanted to show you what it looks like.

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And I wanna indicate an important thing about the shape

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of the fibula.

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When you are dealing with low lateral ligaments, such

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as the anterior talo fibula

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and the posterior talo fibula, this is the shape

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of the fibula that you will see in your axial images.

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That tells you with this concavity on the medial aspect

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of it, that you are dealing

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with the low lateral ligaments.

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Now, another point I wanna make about the anterior pallo

5:05

fibrile ligament, I like to see it on two consecutive axial

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or transverse images.

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And the reason you should see it on two, not one

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is often it has more than one bundle.

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You can identify a larger and thicker superior bundle.

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I'm showing you that here with the orange arrows. Okay?

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All right. So this is, uh, a, a one band

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or bundle of the ligament,

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and then there is an inferior band

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or a bundle, which tends to be smaller, that is intimate

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with the calcan fibrile ligament.

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So that is why typically in most normal persons,

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you will see this particular ligament on two consecutive

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transverse images.

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We turn to the third lateral ligament,

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which is the long extracapsular

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Ligament known as the calcan fibula ligament.

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It extends obliquely backward, okay?

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From the fibula to the calcaneus corresponding

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to this particular picture,

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and it attaches to one

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of those three bumps on the lateral surface of the,

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uh, calcaneus.

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Okay? And that is a very helpful clue to, to

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the attachment side of this ligament.

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And in fact, I use that often to identify

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the lower part of this ligament

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and then follow it as I move upward of my axial images

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to reach the fibula.

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All right? Remember again, this is a stabilizer, not just

6:43

of the ankle joint, but the posterior sub joint.

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This is in a cadaver, the MR image.

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Not beautiful, but it's a nice demonstration of two

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of the low lateral ligaments.

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This is the posterior talo fbri ligament.

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There's the concavity

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that I mentioned on the medial aspect of the fibula.

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This is what it looks like

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extending horizontally across from fibula to TAUs.

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And here is the calcaneal fibrile ligament attaching

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to a bump on the lateral aspect of the calcaneus.

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You can see it here,

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and I wanna point out that nearby are the perineal tendons,

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the brevis above the longest below.

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In the old days, we used to do a lot

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of ankle arthrography when I was a resident, in fact,

7:31

in New York, to look for acute tears of these ligaments.

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And when we filled the ankle with contrast material,

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even though the calcan fibrile ligament was extra capsular,

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often the capsule was ruptured.

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And we would recognize it

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because we would get contrast material

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around the perineal tendons.