The clinical anatomy of the ligament of Barkow at the proximal tibiofibular joint

Introduction: Mention of the ligament of Barkow at the proximal tibiofibular joint is rarely found in the literature and it is not represented in most anatomical atlases. To our knowledge, quantitation of this structure has not been performed. As injury to the knee region is so common, a comprehensive knowledge of this regional anatomy is important to the clinician and surgeon alike. Materials and Methods: Forty lower limbs from embalmed cadavers underwent dissection of the proximal leg with special attention toward the presence or absence of ligament of Barkow. When identified, measurements of this structure were made. Results: The ligament of Barkow was identified in 95% of specimens. For right sides, the mean width was 1.5 cm and the mean length was 1.2 cm. For left sides, the mean width of this ligament was 1.2 cm and the mean length was 1.5 cm. The mean thickness of ligament of Barkow was 1.2 mm (range 0.9-1.4 mm). The upper edge of this ligament was on average 3 cm inferior to the inferior most aspect of the proximal tibiofibular joint. The lower edge of ligament of Barkow was a mean distance of 7 mm from the anterior tibial artery at its entrance into the anterior compartment of the leg. One ligament was found to be fully ossified; thereby, creating a bony bar superior to the anterior tibial vessels. Conclusions: Our hopes are these data will help further elucidate the ligament of Barkow. Imaging studies are now necessary to further elucidate functional and pathological involvement of this structure.