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The null hypothesis was that lateral ankle ligament injury does not affect the stability of syndesmosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Sixteen fresh\u2010frozen above\u2010knee amputated cadaveric specimens were divided into two groups of eight specimens that underwent arthroscopic evaluation of the distal tibiofibular joint. In both the groups, the assessment was first done with all syndesmotic and ankle ligaments intact. Thereafter, Group 1 underwent sequential transection of the three lateral ankle ligaments first to identify the effects of lateral ligament injury: (1) anterior talofibular ligament (ATFL), (2) calcaneofibular ligament (CFL), (3) posterior talofibular ligament (PTFL), then followed by the syndesmotic ligaments, (4) AITFL, (5) Interosseous ligament (IOL), and (6) PITFL. Group 2 underwent sequential transection of the (1) AITFL, (2) ATFL, (3) CFL, (4) IOL, (5) PTFL, and (6) PITFL, which represent the most commonly injured pattern in ankle sprain. In all scenarios, four loading conditions were considered under 100\u00a0N of direct force: (1) unstressed, (2) a lateral fibular hook test, (3) anterior to posterior (AP) fibular translation test, and (4) posterior to anterior (PA) fibular translation test. Distal tibiofibular coronal plane diastasis at the anterior and posterior third of syndesmosis, as well as AP and PA sagittal plane translation, were arthroscopically measured.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The distal tibiofibular joint remained stable after transection of all lateral ankle ligaments (ATFL, CFL, and PTFL) as well as the AITFL. However, after additional transection of the IOL, the syndesmosis became unstable in both the coronal and sagittal plane. Syndesmosis laxity in the coronal plane was also observed after transection of the ATFL, CFL, AITFL, and IOL. Subsequent transection of the PITFL precipitated syndesmosis laxity in the sagittal plane, as well.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The findings from the present study suggest that lateral ankle ligament injuries itself do not directly affect the stability of syndesmosis. However, if it combines with IOL injuries, even partial injuries cause syndesmotic laxity. As a clinical relevance, accurate diagnosis is the key for surgeons to determine syndesmosis fixation whether there is only AITFL injury or combined IOL injury in concomitant acute syndesmotic and lateral ligament injury.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-022-06985-6","type":"journal-article","created":{"date-parts":[[2022,5,6]],"date-time":"2022-05-06T17:14:41Z","timestamp":1651857281000},"page":"3881-3887","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Isolated injuries to the lateral ankle ligaments have no direct effect on syndesmotic stability"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2259-1019","authenticated-orcid":false,"given":"Go","family":"Sato","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School Boston MA 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USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noortje","family":"Hagemeijer","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School Boston MA USA"},{"name":"<!--<label>4<\/label>--> Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam Movement Sciences University of Amsterdam Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart","family":"Lubberts","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaheh Ziaei","family":"Ziabari","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"DiGiovanni","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School Boston MA USA"},{"name":"<!--<label>5<\/label>--> Foot &amp; Ankle Service, Department of Orthopaedic Surgery Massachusetts General Hospital, Harvard Medical School Boston MA USA"},{"name":"<!--<label>6<\/label>--> Newton\u2010Wellesley Hospital, Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Guss","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Foot and Ankle Research and Innovation Laboratory Massachusetts General Hospital, Harvard Medical School Boston MA USA"},{"name":"<!--<label>5<\/label>--> Foot &amp; Ankle Service, Department of Orthopaedic Surgery Massachusetts 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