The tibiofibular mortise - anatomical controversies and their clinical importance: a historical and pictorial essay.

Introduction: During 280 years of studies of the anatomy of the distal tibiofibular articulation, there have arisen many unclear issues regarding the description of individual structures and their terminology. These historical inaccuracies were subsequently reflected in the clinical practice.

Materials and methods: A literature search of original publications and historical sources was performed.

Results: The distal tibiofibular articulation is a synovial joint, rather than a syndesmosis, as it is an integral part of the ankle joint. The interosseous tibiofibular ligament (ITFL), described for the first time by a French anatomist Bichat in 1801, is the strongest ligament of the tibiofibular mortise. Unfortunately, this clinically important ligament is not recognized by the current international anatomical nomenclature. The terms anterior inferior (AITFL) and posterior inferior tibiofibular ligaments (PITFL) are historical remnants "reimported" from the American/British literature and should not be used, because the analogous superior ligaments do not exist. The intermalleolar ligament, first described by Weitbrecht in 1742, is a variable, but constant, structure reinforcing the posterior capsule of the ankle joint. The term inferior transverse ligament (IFT) denoting in the English literature the inferior part of the posterior tibiofibular ligament was originally used for the intermalleolar ligament. The IFT ligament is a part of the posterior tibiofibular ligament and there is no reason to stress its importance.

Conclusion: The chaos in the anatomy, terminology and depiction of the articulation of the distal tibia and fibula, unparalleled in any other joint of the human body, is the result of historical development. A certain negative role was, in this respect, played also by Basiliensia Nomina Anatomica (1895), that eradicated ITFL and called the distal tibiofibular joint a syndesmosis.