Syndesmotic ligaments of the ankle: Anatomy, multimodality imaging, and patterns of injury

Abstract Injuries to the syndesmotic ligaments of the ankle or “high ankle sprains” are common in acute ankle trauma but can be difficult to diagnose both clinically and on imaging. Missed injuries to the syndesmosis can lead to chronic ankle instability, which can cause persistent pain and lead to early osteoarthritis. This review will illustrate the anatomy of the syndesmotic ligamentous complex, describe radiographic, CT, and MR imaging of the syndesmosis, demonstrate typical mechanisms of injuries and associated fracture patterns, and provide an overview of important management considerations.