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Collateral Ligaments of the Ankle: High-Resolution MR Imaging with a Local Gradient Coil and Anatomic Correlation in Cadavers¹

¹ From the Departments of Radiology (C.M., L.R.F., T.R., L.Y., E.C.W., A.S., R.W.M.D., D.T., D.R.) and Pathology (P.H.), Veterans Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161; the Department of Pathology, University of California, San Diego (P.H.); and the Department of Diagnostic Radiology, University of Kiel, Kiel, Germany (C.M.). Received May 4, 1998; revision requested May 27 and received June 15; accepted June 23. Supported in part by Veterans Affairs grant SA360 and the Deutsche Forschungsgemeinschaft. Address reprint requests to D.R.

View larger version (32K): [in a new window]   Figure 1a.  Drawings of the normal anatomy of the lateral (a) and medial (b) collateral ligaments of the ankle.

View larger version (31K): [in a new window]   Figure 1b.  Drawings of the normal anatomy of the lateral (a) and medial (b) collateral ligaments of the ankle.

View larger version (175K): [in a new window]   Figure 2a.  Axial sections through the ankle of the cadaver of a 69-year-old woman. (a) T1-weighted spin-echo MR image (600/20) shows the anterior talofibular ligament (straight white arrows) as a thin band of homogeneous signal intensity. The posterior talofibular ligament (black arrows) has inhomogeneous signal intensity at the insertion on the concave fibula. Also note the inhomogeneous signal intensity of the anterior (arrowhead) and posterior (curved arrow) tibiotalar ligaments. (b) Photograph of corresponding macroscopic section shows the anterior talofibular ligament (thick arrows) and posterior talofibular ligament (thin arrows). (c) Photomicrograph (original magnification, x16; hematoxylin-eosin stain) of corresponding microscopic section shows multiple fascicles (arrowheads) of the posterior talofibular ligament with fatty tissue (arrows) close to the insertion on the fibula (F).

View larger version (128K): [in a new window]   Figure 2b.  Axial sections through the ankle of the cadaver of a 69-year-old woman. (a) T1-weighted spin-echo MR image (600/20) shows the anterior talofibular ligament (straight white arrows) as a thin band of homogeneous signal intensity. The posterior talofibular ligament (black arrows) has inhomogeneous signal intensity at the insertion on the concave fibula. Also note the inhomogeneous signal intensity of the anterior (arrowhead) and posterior (curved arrow) tibiotalar ligaments. (b) Photograph of corresponding macroscopic section shows the anterior talofibular ligament (thick arrows) and posterior talofibular ligament (thin arrows). (c) Photomicrograph (original magnification, x16; hematoxylin-eosin stain) of corresponding microscopic section shows multiple fascicles (arrowheads) of the posterior talofibular ligament with fatty tissue (arrows) close to the insertion on the fibula (F).

View larger version (166K): [in a new window]   Figure 2c.  Axial sections through the ankle of the cadaver of a 69-year-old woman. (a) T1-weighted spin-echo MR image (600/20) shows the anterior talofibular ligament (straight white arrows) as a thin band of homogeneous signal intensity. The posterior talofibular ligament (black arrows) has inhomogeneous signal intensity at the insertion on the concave fibula. Also note the inhomogeneous signal intensity of the anterior (arrowhead) and posterior (curved arrow) tibiotalar ligaments. (b) Photograph of corresponding macroscopic section shows the anterior talofibular ligament (thick arrows) and posterior talofibular ligament (thin arrows). (c) Photomicrograph (original magnification, x16; hematoxylin-eosin stain) of corresponding microscopic section shows multiple fascicles (arrowheads) of the posterior talofibular ligament with fatty tissue (arrows) close to the insertion on the fibula (F).

View larger version (172K): [in a new window]   Figure 3a.  Axial sections through the ankle of the cadaver of a 74-year-old woman. (a) T1-weighted spin-echo MR image (600/20) shows only thin fibers of the anterior tibiotalar ligament (curved arrow). The posterior tibiotalar ligament (straight arrow) appears as a thick, inhomogeneous band with broad attachment to the medial surface of the talus. (b, c) Corresponding MR images obtained 3 mm (b) and 6 mm (c) below the level of a show thin fibers of the tibionavicular ligament (arrowheads). (d) Photograph of corresponding macroscopic section shows the anterior tibiotalar ligament (curved arrow) and posterior tibiotalar ligament (straight arrow). (e) Photomicrograph (original magnification, x16; hematoxylin-eosin stain) of corresponding microscopic section shows areas of fatty tissue (arrows) between the fascicles (arrowheads) of the posterior tibiofibular ligament. These findings correspond to the inhomogeneous signal intensity on T1-weighted spin-echo MR images.

View larger version (190K): [in a new window]   Figure 3b.  Axial sections through the ankle of the cadaver of a 74-year-old woman. (a) T1-weighted spin-echo MR image (600/20) shows only thin fibers of the anterior tibiotalar ligament (curved arrow). The posterior tibiotalar ligament (straight arrow) appears as a thick, inhomogeneous band with broad attachment to the medial surface of the talus. (b, c) Corresponding MR images obtained 3 mm (b) and 6 mm (c) below the level of a show thin fibers of the tibionavicular ligament (arrowheads). (d) Photograph of corresponding macroscopic section shows the anterior tibiotalar ligament (curved arrow) and posterior tibiotalar ligament (straight arrow). (e) Photomicrograph (original magnification, x16; hematoxylin-eosin stain) of corresponding microscopic section shows areas of fatty tissue (arrows) between the fascicles (arrowheads) of the posterior tibiofibular ligament. These findings correspond to the inhomogeneous signal intensity on T1-weighted spin-echo MR images.

View larger version (191K): [in a new window]   Figure 3c.  Axial sections through the ankle of the cadaver of a 74-year-old woman. (a) T1-weighted spin-echo MR image (600/20) shows only thin fibers of the anterior tibiotalar ligament (curved arrow). The posterior tibiotalar ligament (straight arrow) appears as a thick, inhomogeneous band with broad attachment to the medial surface of the talus. (b, c) Corresponding MR images obtained 3 mm (b) and 6 mm (c) below the level of a show thin fibers of the tibionavicular ligament (arrowheads). (d) Photograph of corresponding macroscopic section shows the anterior tibiotalar ligament (curved arrow) and posterior tibiotalar ligament (straight arrow). (e) Photomicrograph (original magnification, x16; hematoxylin-eosin stain) of corresponding microscopic section shows areas of fatty tissue (arrows) between the fascicles (arrowheads) of the posterior tibiofibular ligament. These findings correspond to the inhomogeneous signal intensity on T1-weighted spin-echo MR images.

View larger version (140K): [in a new window]   Figure 3d.  Axial sections through the ankle of the cadaver of a 74-year-old woman. (a) T1-weighted spin-echo MR image (600/20) shows only thin fibers of the anterior tibiotalar ligament (curved arrow). The posterior tibiotalar ligament (straight arrow) appears as a thick, inhomogeneous band with broad attachment to the medial surface of the talus. (b, c) Corresponding MR images obtained 3 mm (b) and 6 mm (c) below the level of a show thin fibers of the tibionavicular ligament (arrowheads). (d) Photograph of corresponding macroscopic section shows the anterior tibiotalar ligament (curved arrow) and posterior tibiotalar ligament (straight arrow). (e) Photomicrograph (original magnification, x16; hematoxylin-eosin stain) of corresponding microscopic section shows areas of fatty tissue (arrows) between the fascicles (arrowheads) of the posterior tibiofibular ligament. These findings correspond to the inhomogeneous signal intensity on T1-weighted spin-echo MR images.

View larger version (206K): [in a new window]   Figure 3e.  Axial sections through the ankle of the cadaver of a 74-year-old woman. (a) T1-weighted spin-echo MR image (600/20) shows only thin fibers of the anterior tibiotalar ligament (curved arrow). The posterior tibiotalar ligament (straight arrow) appears as a thick, inhomogeneous band with broad attachment to the medial surface of the talus. (b, c) Corresponding MR images obtained 3 mm (b) and 6 mm (c) below the level of a show thin fibers of the tibionavicular ligament (arrowheads). (d) Photograph of corresponding macroscopic section shows the anterior tibiotalar ligament (curved arrow) and posterior tibiotalar ligament (straight arrow). (e) Photomicrograph (original magnification, x16; hematoxylin-eosin stain) of corresponding microscopic section shows areas of fatty tissue (arrows) between the fascicles (arrowheads) of the posterior tibiofibular ligament. These findings correspond to the inhomogeneous signal intensity on T1-weighted spin-echo MR images.

View larger version (189K): [in a new window]   Figure 4a.  Coronal sections through the ankle of the cadaver of a 67-year-old woman. (a) T1-weighted spin-echo MR image (600/20) shows the posterior talofibular ligament (arrowhead), which originates from the concave surface of the fossa of the lateral malleolus and extends to the insertion on the talus. The calcaneofibular ligament (arrow) appears as a thin band of homogeneous signal intensity, which extends from the apex of the lateral malleolus to the lateral aspect of the calcaneus. Pb = peroneus brevis tendon, Pl = peroneus longus tendon. (b) Photograph of corresponding macroscopic section shows the posterior talofibular ligament (arrowhead) and calcaneofibular ligament (arrow). The inhomogeneous signal intensity of the posterior talofibular ligament on the MR image (a) corresponds to multiple fascicles with areas of interspersed fatty tissue. (c) Corresponding MR image obtained 6 mm posterior to a shows the transverse ligament (arrowheads) and posterior tibiofibular ligament (arrow) of the distal tibiofibular syndesmosis. The transverse ligament appears as a thin band of homogeneous signal intensity below the posterior tibiofibular ligament that extends obliquely to the tibia.

View larger version (123K): [in a new window]   Figure 4b.  Coronal sections through the ankle of the cadaver of a 67-year-old woman. (a) T1-weighted spin-echo MR image (600/20) shows the posterior talofibular ligament (arrowhead), which originates from the concave surface of the fossa of the lateral malleolus and extends to the insertion on the talus. The calcaneofibular ligament (arrow) appears as a thin band of homogeneous signal intensity, which extends from the apex of the lateral malleolus to the lateral aspect of the calcaneus. Pb = peroneus brevis tendon, Pl = peroneus longus tendon. (b) Photograph of corresponding macroscopic section shows the posterior talofibular ligament (arrowhead) and calcaneofibular ligament (arrow). The inhomogeneous signal intensity of the posterior talofibular ligament on the MR image (a) corresponds to multiple fascicles with areas of interspersed fatty tissue. (c) Corresponding MR image obtained 6 mm posterior to a shows the transverse ligament (arrowheads) and posterior tibiofibular ligament (arrow) of the distal tibiofibular syndesmosis. The transverse ligament appears as a thin band of homogeneous signal intensity below the posterior tibiofibular ligament that extends obliquely to the tibia.

View larger version (165K): [in a new window]   Figure 4c.  Coronal sections through the ankle of the cadaver of a 67-year-old woman. (a) T1-weighted spin-echo MR image (600/20) shows the posterior talofibular ligament (arrowhead), which originates from the concave surface of the fossa of the lateral malleolus and extends to the insertion on the talus. The calcaneofibular ligament (arrow) appears as a thin band of homogeneous signal intensity, which extends from the apex of the lateral malleolus to the lateral aspect of the calcaneus. Pb = peroneus brevis tendon, Pl = peroneus longus tendon. (b) Photograph of corresponding macroscopic section shows the posterior talofibular ligament (arrowhead) and calcaneofibular ligament (arrow). The inhomogeneous signal intensity of the posterior talofibular ligament on the MR image (a) corresponds to multiple fascicles with areas of interspersed fatty tissue. (c) Corresponding MR image obtained 6 mm posterior to a shows the transverse ligament (arrowheads) and posterior tibiofibular ligament (arrow) of the distal tibiofibular syndesmosis. The transverse ligament appears as a thin band of homogeneous signal intensity below the posterior tibiofibular ligament that extends obliquely to the tibia.

View larger version (164K): [in a new window]   Figure 5a.  Coronal sections through the ankle of the cadaver of a 76-year-old woman. (a) T1-weighted spin-echo MR image (600/20) shows the posterior tibiotalar ligament (arrows) as a short, thick band that extends from the tip of the medial malleolus to the medial talar surface. (b) Photograph of corresponding macroscopic section shows the posterior tibiotalar ligament (arrows).

View larger version (144K): [in a new window]   Figure 5b.  Coronal sections through the ankle of the cadaver of a 76-year-old woman. (a) T1-weighted spin-echo MR image (600/20) shows the posterior tibiotalar ligament (arrows) as a short, thick band that extends from the tip of the medial malleolus to the medial talar surface. (b) Photograph of corresponding macroscopic section shows the posterior tibiotalar ligament (arrows).

View larger version (143K): [in a new window]   Figure 6a.  Coronal sections through the ankle of the cadaver of an 86-year-old woman. D = flexor digitorum longus tendon, S = sustentaculum tali of the calcaneus, T = tibialis posterior tendon. (a) T1-weighted spin-echo MR image (600/20) shows multiple fascicles of the posterior tibiotalar ligament (black arrow) with hyperintense layers (white arrow) of fatty tissue between the fascicles. The superficial layer of the medial collateral ligament, the tibiocalcaneal ligament (arrowhead), is shown as a small, homogeneous band of low signal intensity lateral to the posterior tibiotalar ligament (deep layer of the medial collateral ligament). (b) Corresponding MR image obtained 3 mm posterior to a shows the posterior tibiotalar ligament (arrow) and tibiocalcaneal ligament (arrowheads), which extends to the sustentaculum tali of the calcaneus. The tibiocalcaneal ligament can be easily differentiated from the tibialis posterior and flexor digitorum longus tendons. (c) Photograph of corresponding macroscopic section shows the posterior tibiotalar ligament (arrow) and tibiocalcaneal ligament (arrowheads).

View larger version (142K): [in a new window]   Figure 6b.  Coronal sections through the ankle of the cadaver of an 86-year-old woman. D = flexor digitorum longus tendon, S = sustentaculum tali of the calcaneus, T = tibialis posterior tendon. (a) T1-weighted spin-echo MR image (600/20) shows multiple fascicles of the posterior tibiotalar ligament (black arrow) with hyperintense layers (white arrow) of fatty tissue between the fascicles. The superficial layer of the medial collateral ligament, the tibiocalcaneal ligament (arrowhead), is shown as a small, homogeneous band of low signal intensity lateral to the posterior tibiotalar ligament (deep layer of the medial collateral ligament). (b) Corresponding MR image obtained 3 mm posterior to a shows the posterior tibiotalar ligament (arrow) and tibiocalcaneal ligament (arrowheads), which extends to the sustentaculum tali of the calcaneus. The tibiocalcaneal ligament can be easily differentiated from the tibialis posterior and flexor digitorum longus tendons. (c) Photograph of corresponding macroscopic section shows the posterior tibiotalar ligament (arrow) and tibiocalcaneal ligament (arrowheads).

View larger version (144K): [in a new window]   Figure 6c.  Coronal sections through the ankle of the cadaver of an 86-year-old woman. D = flexor digitorum longus tendon, S = sustentaculum tali of the calcaneus, T = tibialis posterior tendon. (a) T1-weighted spin-echo MR image (600/20) shows multiple fascicles of the posterior tibiotalar ligament (black arrow) with hyperintense layers (white arrow) of fatty tissue between the fascicles. The superficial layer of the medial collateral ligament, the tibiocalcaneal ligament (arrowhead), is shown as a small, homogeneous band of low signal intensity lateral to the posterior tibiotalar ligament (deep layer of the medial collateral ligament). (b) Corresponding MR image obtained 3 mm posterior to a shows the posterior tibiotalar ligament (arrow) and tibiocalcaneal ligament (arrowheads), which extends to the sustentaculum tali of the calcaneus. The tibiocalcaneal ligament can be easily differentiated from the tibialis posterior and flexor digitorum longus tendons. (c) Photograph of corresponding macroscopic section shows the posterior tibiotalar ligament (arrow) and tibiocalcaneal ligament (arrowheads).