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Ligamentous ankle injuries in relation to the morphology of the incisura fibularis : a systematic review

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Abstract
Importance Ligamentous ankle lesions are among the most frequent sport injuries. One of the key intrinsic stabilizers of the ankle joint is the incisura fibularis (IF), as it interlocks the distal tibia and fibula. Despite an abundant amount of studies related to ligamentous ankle injuries, scant attention has been given to the specific role of the IF morphology. Objective We systematically reviewed all literature focused on the relation between ligamentous ankle lesions and IF morphology. Evidence Review A systematic literature search was conducted on PubMed, Embase and Web of Science according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines and registered on the International prospective register of systematic reviews (PROSPERO) database (CRD42021282862). In general, search terms were related to ankle and syndesmosis trauma/instability in combination with morphology parameters of the incisura fibularis. Studies categorizable as original research (randomized controlled trial or observational) were included. Studies concerning degenerative ankle disease and cadavers were excluded. Findings Thirteen studies were confirmed eligible and consisted of a prospective cohort (n=1), retrospective comparative (n=10), and observational (n=2) study design. Several studies have found an increased number of ankle ligament injuries and a higher incidence of chronic ankle instability in association with a shallow IF depth. In addition, statistically significant differences in incisura height and angle were also noted: a shorter incisura and more obtuse angle were more present in patients with ankle ligament injuries. Conclusion and Relevance The majority of studies found distinct characteristics of the IF morphology associated with ligamentous ankle lesions, potentially due to lower osseous resistance against tibiofibular displacement. However, not all studies could identify this association and presented a heterogeneous methodological quality. Therefore, further prospective studies are warranted to clarify the relation between the IF morphology and ligamentous ankle injuries.
Keywords
Ankle instability, Ankle injury, Incisura fibularis, Fibular notch, Tibiofibular morphometrics, Morphological analysis, SYNDESMOSIS, SPRAIN, CT, EPIDEMIOLOGY, INSTABILITY, MANAGEMENT, FRACTURE, ANATOMY

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MLA
Wittouck, Louise, et al. “Ligamentous Ankle Injuries in Relation to the Morphology of the Incisura Fibularis : A Systematic Review.” JOURNAL OF ISAKOS JOINT DISORDERS & ORTHOPAEDIC SPORTS MEDICINE, vol. 10, 2025, doi:10.1016/j.jisako.2024.100361.
APA
Wittouck, L., Vermeir, R., Peiffer, M., Huysse, W., Pringels, L., Martinelli, N., … Burssens, A. (2025). Ligamentous ankle injuries in relation to the morphology of the incisura fibularis : a systematic review. JOURNAL OF ISAKOS JOINT DISORDERS & ORTHOPAEDIC SPORTS MEDICINE, 10. https://doi.org/10.1016/j.jisako.2024.100361
Chicago author-date
Wittouck, Louise, Ruben Vermeir, Matthias Peiffer, Wouter Huysse, Lauren Pringels, Nicolò Martinelli, Emmanuel Audenaert, and Arne Burssens. 2025. “Ligamentous Ankle Injuries in Relation to the Morphology of the Incisura Fibularis : A Systematic Review.” JOURNAL OF ISAKOS JOINT DISORDERS & ORTHOPAEDIC SPORTS MEDICINE 10. https://doi.org/10.1016/j.jisako.2024.100361.
Chicago author-date (all authors)
Wittouck, Louise, Ruben Vermeir, Matthias Peiffer, Wouter Huysse, Lauren Pringels, Nicolò Martinelli, Emmanuel Audenaert, and Arne Burssens. 2025. “Ligamentous Ankle Injuries in Relation to the Morphology of the Incisura Fibularis : A Systematic Review.” JOURNAL OF ISAKOS JOINT DISORDERS & ORTHOPAEDIC SPORTS MEDICINE 10. doi:10.1016/j.jisako.2024.100361.
Vancouver
1.
Wittouck L, Vermeir R, Peiffer M, Huysse W, Pringels L, Martinelli N, et al. Ligamentous ankle injuries in relation to the morphology of the incisura fibularis : a systematic review. JOURNAL OF ISAKOS JOINT DISORDERS & ORTHOPAEDIC SPORTS MEDICINE. 2025;10.
IEEE
[1]
L. Wittouck et al., “Ligamentous ankle injuries in relation to the morphology of the incisura fibularis : a systematic review,” JOURNAL OF ISAKOS JOINT DISORDERS & ORTHOPAEDIC SPORTS MEDICINE, vol. 10, 2025.
@article{01JCB38BKHG3WCH5YC4EQBYWZY,
  abstract     = {{Importance
Ligamentous ankle lesions are among the most frequent sport injuries. One of the key intrinsic stabilizers of the ankle joint is the incisura fibularis (IF), as it interlocks the distal tibia and fibula. Despite an abundant amount of studies related to ligamentous ankle injuries, scant attention has been given to the specific role of the IF morphology.
Objective
We systematically reviewed all literature focused on the relation between ligamentous ankle lesions and IF morphology.
Evidence Review
A systematic literature search was conducted on PubMed, Embase and Web of Science according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines and registered on the International prospective register of systematic reviews (PROSPERO) database (CRD42021282862). In general, search terms were related to ankle and syndesmosis trauma/instability in combination with morphology parameters of the incisura fibularis. Studies categorizable as original research (randomized controlled trial or observational) were included. Studies concerning degenerative ankle disease and cadavers were excluded.
Findings
Thirteen studies were confirmed eligible and consisted of a prospective cohort (n=1), retrospective comparative (n=10), and observational (n=2) study design. Several studies have found an increased number of ankle ligament injuries and a higher incidence of chronic ankle instability in association with a shallow IF depth. In addition, statistically significant differences in incisura height and angle were also noted: a shorter incisura and more obtuse angle were more present in patients with ankle ligament injuries.
Conclusion and Relevance
The majority of studies found distinct characteristics of the IF morphology associated with ligamentous ankle lesions, potentially due to lower osseous resistance against tibiofibular displacement. However, not all studies could identify this association and presented a heterogeneous methodological quality. Therefore, further prospective studies are warranted to clarify the relation between the IF morphology and ligamentous ankle injuries.}},
  articleno    = {{100361}},
  author       = {{Wittouck, Louise and Vermeir, Ruben and Peiffer, Matthias and Huysse, Wouter and Pringels, Lauren and Martinelli, Nicolò and Audenaert, Emmanuel and Burssens, Arne}},
  issn         = {{2059-7754}},
  journal      = {{JOURNAL OF ISAKOS JOINT DISORDERS & ORTHOPAEDIC SPORTS MEDICINE}},
  keywords     = {{Ankle instability,Ankle injury,Incisura fibularis,Fibular notch,Tibiofibular morphometrics,Morphological analysis,SYNDESMOSIS,SPRAIN,CT,EPIDEMIOLOGY,INSTABILITY,MANAGEMENT,FRACTURE,ANATOMY}},
  language     = {{eng}},
  pages        = {{13}},
  title        = {{Ligamentous ankle injuries in relation to the morphology of the incisura fibularis : a systematic review}},
  url          = {{http://doi.org/10.1016/j.jisako.2024.100361}},
  volume       = {{10}},
  year         = {{2025}},
}

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