Purpose:​ Our goal was to correlate high-resolution MR images of the tibiofibular syndesmosis with anatomic sections.

Method:​ MRI was performed inside a local gradient coil on six cadaveric feet taped in 10-20° dorsiflexion and 40-50° plantar flexion by using axial and coronal T1-weighted SE sequences. After imaging, the specimens were frozen and sectioned into 3-mm-thick slices along the MR planes. Images were correlated with the anatomic sections.

Results:​ MRI depicted the anatomy of the tibiofibular syndesmosis and surrounding structures. With the foot taped in dorsiflexion, axial imaging provided optimum views of the anterior, posterior, interosseous, and transverse tibiofibular ligaments. Coronal images allowed visualization of the entire course of the anterior, posterior, and transverse tibiofibular ligaments. The multifascicular appearance of the anterior tibiofibular ligament was best visualized in coronal sections. With the foot taped in dorsiflexion or in plantar flexion, it was possible to distinguish the posterior tibiofibular ligament and transverse tibiofibular ligament from the posterior talofibular ligament in all specimens.

Conclusion:​ High-resolution MRI using a local gradient coil provides excellent delineation of the ligaments of the distal tibiofibular syndesmosis.