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Anatomic Variations and MRI of the Intermalleolar Ligament

Chang-Seok Oh1, Hyung-Sun Won2, Mi-Sun Hur2, In-Hyuk Chung2, Sungjun Kim3,4, Jin-Suck Suh3 and Ki-Sun Sung5

1 Department of Anatomy, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, 440-746, Korea.
2 Department of Anatomy and Brain Korea 21 Project for Medical Science, Seoul, Korea.
3 Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, 120-752, Korea.
4 Present address: Department of Diagnostic Radiology, Hanyang University College of Medicine, Seoul, 133-791, Korea.
5 Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710, Korea.


Figure 1
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  		Fig. 1A —Dissected ankle and coronal MR image shows intermalleolar ligament (IML) in shape of thick string. IML arises from lateral border of medial malleolar sulcus (MM) and runs to lateral malleolus (LM) with posterior talofibular ligament (PTF). FHL = flexor hallucis longus.

 

Figure 2
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  		Fig. 1B —Dissected ankle and coronal MR image shows intermalleolar ligament (IML) in shape of thick string. IML shown as thick string under inferior transverse ligament (ITL) in posterior ankle space. Oval structure composed of multiple dots on sagittal MR image of same specimen is noted in circle (arrow), representing cross-sectioned bundles of fibers composing ligament.

 

Figure 3
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  		Fig. 2A —Cadaveric specimen shows intermalleolar ligament (IML) of band shape and its coronal MR image. IML is medially continuous with septum between flexor digitorum longus (FDL) and tibialis posterior and narrows laterally to lateral malleolus. Some strands of ligament were connected to midpoint of posterior distal margin of tibia. FHL = flexor hallucis longus, PTF = posterior talofibular ligament.

 

Figure 4
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  		Fig. 2B —Cadaveric specimen shows intermalleolar ligament (IML) of band shape and its coronal MR image. Coronal MR image of same specimen shown in A. IML is observed as two stripes, which represent fiber bundles composing ligament.

 

Figure 5
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  		Fig. 3A —Cadaveric specimen shows intermalleolar ligament (IML) wider than in Figures 2A and 2B and its coronal MR image. IML arises from medial border of medial malleolar sulcus through septum between flexor digitorum longus (FDL) and tibialis posterior and from medial half of posterior distal margin of tibia. Ligament narrows laterally toward lateral malleolus (LM) with posterior talofibular ligament (PTF). FHL = flexor hallucis longus.

 

Figure 6
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  		Fig. 3B —Cadaveric specimen shows intermalleolar ligament (IML) wider than in Figures 2A and 2B and its coronal MR image. Coronal MR image of same specimen shown in A. IML appears as multiple stripes, which represent multiple fiber bundles composing ligament.

 

Figure 7
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  		Fig. 4A —Dissection of intermalleolar ligament (IML) of band shape and its axial MR image. IML is connected to two different sites of posterior distal margin of tibia. Septum between flexor digitorum longus and tibialis posterior (TP), with which ligament was continuous medially, has been removed to show TP. FHL = flexor hallucis longus, PTF = posterior talofibular ligament.

 

Figure 8
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  		Fig. 4B —Dissection of intermalleolar ligament (IML) of band shape and its axial MR image. Axial MR image of same specimen shown in A. IML runs medially between flexor digitorum longus (FDL) and TP and attaches laterally to lateral malleolus (LM). Small portion of posterior talofibular ligament is indicated by asterisk.

 

Figure 9
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  		Fig. 5 —Thin fascicle (arrowhead) connects posterior talofibular ligament (PTF) with posterior distal margin of tibia.

 

Figure 10
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  		Fig. 6A —Cadaveric specimen shows sagittally sectioned intermalleolar ligament (IML) and its sagittal MR image. Sagittal section of cadaveric ankle showing three cross-sectioned bundles of fibers (arrowheads) composing IML. They are located posteriorly between tibia (Tb) and talus (T) and in front of flexor hallucis longus (FHL).

 

Figure 11
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  		Fig. 6B —Cadaveric specimen shows sagittally sectioned intermalleolar ligament (IML) and its sagittal MR image. Sagittal MR image of same specimen corresponding to A. Three low-signal-intensity spots (arrowheads) represent cross-sectioned bundles shown in A.

 

Figure 12
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  		Fig. 7A —Same cadaveric specimen shows sagittally sectioned intermalleolar ligament (IML) in more lateral part than in Figures 6A and 6B and its sagittal MR image. IML appears as linear structure between inferior transverse ligament (ITL) and posterior talofibular ligament (PTF). FHL = flexor hallucis longus, T = talus, Tb = tibia.

 

Figure 13
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  		Fig. 7B —Same cadaveric specimen shows sagittally sectioned intermalleolar ligament (IML) in more lateral part than in Figures 6A and 6B and its sagittal MR image. Sagittal MR image corresponding to A. IML is linear and in same place as shown in A.

 

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