Figure 2

Dynamic Ultrasound views of the Left clear space with healthy AITFL and the Right clear space with torn AITFL, of the same patient. A: The healthy ligament is seen connecting the tibia to the fibula and with only a minimal measured clear space opening under stress (ER=External Rotation, IR=Internal rotation, N=Neutral). The right torn side shows a marked clear space opening under stress (ER) as there is no continuous ligament to stop separation of the tibia and fibula. Application of Internal Rotation stress tightens the joint, bringing the tibia and fibula closer to each other, in the absence of the AITFL. B: Dynamic Ultrasound views of a Torn AITFL which presents with widened clear space. (ER=External Rotation, IR=Internal rotation, N=Neutral). The injured syndesmosis shows a marked clear space opening under stress (ER) as there is no continuous ligament to stop separation of the tibia and fibula. Application of Internal Rotation stress tightens the joint, bringing the tibia and fibula closer to each other, in the absence of the AITFL.