Though normally a rare injury, you may have heard of the term “high ankle sprain” or “syndesmosis injury” be thrown around a lot more recently, particularly in the NRL. But what is the syndesmosis?
The syndesmosis is actually not a single structure. It is made out of three ligaments around the top of the ankle. These structures are responsible for holding the two leg bones, the tibia and fibula together.


- AITFL- The Anterior Inferior Tibiofibular Ligament, is the ligament one of the ligaments at the end of the two bones
- PITFL- The Posterior Inferior Tibiofibular Ligament, is the second main ligament holding the two bones together
- IOM- Interosseus Ligament lies between the two bones, but a bit higher up
You need a large amount of trauma to injure these muscles. Below is a couple of videos of how they got injured in the rugby league recently
Depending on the severity of the injury, surgery may or may not be needed. Generally, a more severe injury involves the interosseus ligament, and these ones tend to get operated on.
If you aren’t needing an operation, you would generally need to be in a camboot for around 2 weeks, while the injured syndesmosis ligament complex heals.
Following that, rehab is started and is based on your symptoms. Full recovery can be between anywhere from 6 weeks to 12 weeks depending on specific of the injury.