This is because there are no muscles that can control the joint for most activities of daily living. Suspicion of atraumatic injury to the proximal tibiofibular joint warrants extensive inspection during the physical examination of the knee. The drill guide is directed in a posteroanterior direction toward the anteromedial aspect of the proximal tibia, making sure to avoid the MCL and pes anserinus. 1978 Jul;131(1):133-8. doi: 10.2214/ajr.131.1.133. Recurrent dislocation of the proximal tibiofibular joint. With acute injury, patients usually complain of pain and a prominence in the lateral aspect of the knee. A closed reduction should be attempted in patients with acute dislocation. Instability of the proximal tibiofibular joint (PTFJ) may be acute or chronic in etiology and four types of instability initially described by Ogden include anterolateral dislocation, posteromedial dislocation, superior dislocation, and atraumatic subluxation.1Anterolateral dislocation is by far the most common form of instability and the focus of this discussion. Flexing the knee to 90 degrees to relax the lateral collateral ligament and biceps femoris tendon, then moving the fibular head anteriorly and posteriorly, can test instability of the joint. During significant trauma, traumatic dislocations of the tibiofibular joint are commonly missed, so the physical examination of this joint is a significant part of the comprehensive knee examination. 2022 Sep 30;33(3):291-304. doi: 10.31138/mjr.33.3.291. Although many patients do not note symptoms during daily activities, symptoms may develop during activities that require sudden changes in direction. Shapiro G.S., Fanton G.S., Dillingham M.F. A Primer and Practical Guide to the Diagnosis of Joint Pain and Inflammation. Instability of the proximal tibiofibular joint is a very rare condition that is often misdiagnosed when there is no suspicion of the injury. Effects of a Partial Meniscectomy on Articular Cartilage, Femoral Condyle | Articular Cartilage Injury, FCL Injury or Lateral Collateral Ligament LCL Tear, Lateral Patellar Instability | MPFL Repair, Instability of the joint, especially during deep squatting, Concurrent irritation of the common peroneal nerve, because the common peroneal nerve crosses the lateral aspect of the fibular neck within 2-3 cm of the lateral aspect of the fibular head. All other clinical possibilities should be ruled out before a diagnosis is made. Journal of the American Academy of Orthopaedic Surgeons &NA; Injury to the proximal tibiofibular joint is typically seen in athletes whose sports require violent twisting motions of the flexed knee. NCI CPTC Antibody Characterization Program. Atraumatic proximal tibiofibular joint subluxation is the more common presentation of proximal tibiofibular joint instability. The anterior sagittal image demonstrates the normal anterior ligament (green arrow) and the relationship between the anterior ligament, the FCL (yellow arrow), the anterior arm of the short head of the BF tendon (purple arrow), and the anterior arm of the long head of the BF tendon (orange arrow). The clinical presentation of joint injury can range from common idiopathic subluxation with no history of trauma, to less common high-energy traumatic dislocations that may be associated with long bone fracture. Repair with bicortical suspension device restores proximal tibiofibular joint motion. LaPrade RF, Hamilton CD. 1998. Most proximal tibiofibular joint instabilities can be treated with closed reduction and conservative care, but some require internal fixation or soft-tissue reconstruction. MeSH Reconstruction is recommended to maintain correct anatomic function and rotation of the joint. The proximal tibiofibular joint (PTFJ) is the articulation of the lateral tibial plateau of the tibia and the head of the fibula. Conclusions: Preoperative Considerations Many common injuries can cause the same symptoms as proximal tibiofibular dislocation; therefore the integrity of the surrounding ligamentous structures should be investigated before a diagnosis is made. Atraumatic subluxation is thought to result from injury to the anterior ligament and to the anterior capsule of the joint, and it can be associated with Ehlers-Danlos syndrome, muscular dystrophy, and generalized laxity.1 Subluxation typically occurs in patients who have no history of inciting trauma but may have generalized ligamentous laxity; the condition is not commonly bilateral. Injury to the proximal tibiofibular joint is typically seen in athletes whose sports require violent twisting motions of the flexed knee. R. F. (2010). Chapter 92 Epub 2016 Jan 16. Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window) Anatomic Acromioclavicular Joint Reconstruction, Arthroscopic Lateral Retinacular Release and Lateral Retinacular Lengthening, Arthroscopic and Open Management of Scapulothoracic Disorders, Medial Patellofemoral Ligament Reconstruction and Repair for Patellar Instability, Management of Pectoralis Major Muscle Injuries, Combined Anterior Cruciate Ligament Reconstruction and High Tibial Osteotomy, Patient Positioning, Portal Placement, and Normal Arthroscopic Anatomy, Surgical Techniques of the Shoulder Elbow and Knee in Sports. The proximal tibiofibular joint is located between the lateral tibial plateau of the tibia, and the head of the fibula. Although many patients do not note symptoms during daily activities, symptoms may develop during activities that require sudden changes in direction. Published by Elsevier Inc. All rights reserved. Suspicion of atraumatic injury to the proximal tibiofibular joint warrants extensive inspection during the physical examination of the knee. Orthop Rev. 2010 Nov;18(11):1452-5. doi: 10.1007/s00167-010-1049-9. Proximal tibiofibular joint instability is a very unusual and uncommon condition. We advise that patients initiate a program of weaning off the crutches at the six week point and starting the use of a stationary bike to regain the strength of their quadriceps mechanism. Improved outcomes after all forms of PTFJ instability treatment were reported; however, high complication rates were associated with both PTFJ fixation (28%) and fibular head resection (20%). 3. History and physical examination are very important for diagnosis. 2008 Aug;191(2):W44-51. Dirim B, Wangwinyuvirat M, Frank A, Cink V, Pretterklieber ML, Pastore D, Resnick D. Communication between the proximal tibiofibular joint and knee via the subpopliteal recess: MR arthrography with histologic correlation and stratigraphic dissection. The chief function of the proximal tibiofibular joint is to dissipate some of the forces on the lower leg such as torsional stresses on the ankle, lateral tibial bending movements, and tensile weight bearing. Arthritic conditions of the PTFJ are treated similar to those of any diarthrodial joint, with additional option of surgical arthrodesis or resection arthroplasty. Is stability of the proximal tibiofibular joint important in the multiligament-injured knee? We anticipate that our patients will return back to full activities about 4-5 months after surgery, following the rehabilitation program. Epub 2017 Mar 24. 2014 Sep;472(9):2691-7. doi: 10.1007/s11999-014-3574-1. Traumatic dislocations of the proximal tibiofibular joint are uncommon and are normally caused by high-energy injury or a fall on a twisted knee. The diagnosis of joint instability can be confirmed by steroid and local anesthetic injection into the joint under fluoroscopic guidance, if pain is relieved. Rule out lateral meniscus tear. In order to best treat this pathology, Dr. LaPrade and his team have developed an anatomic proximal posterior tibiofibular joint reconstruction procedure. The integrity of the proximal tibiofibular joint is best visualized through plain radiographs. The posterior capsule is identified with the insertion of the biceps femoris tendon (BFT) and the FCL. The systematic review identified 44 studies (96 patients) after inclusion and exclusion criteria application. Joint subluxation is common in adolescents, typically girls, and results from hypermobility of the joint, in which symptoms can decrease with skeletal maturity.2 Some studies have shown that congenital dislocation of the knee can also be associated with atraumatic superior dislocation of the proximal tibiofibular joint.1, Traumatic dislocations of the proximal tibiofibular joint are uncommon and are normally caused by high-energy injury or a fall on a twisted knee. History of Traumatic Injury Limit patients to passive flexion until 6 weeks to reduce the stress that is applied to the reconstructed ligaments (prevent biceps femoris from pulling on the fibular head). Patients often report symptoms such as knee instability and giving way during these activities, as well as clicking and popping during daily activities.3, Traumatic dislocations commonly cause pain along the lateral knee that radiates into the region of the iliotibial band and the patellofemoral joint and is increased with palpation of the prominent fibular head and ankle motion.4 The patients pain commonly limits the range of motion, especially knee extension, and motion of the ankle; the patients ability to bear weight on the affected leg is also limited by pain. PMID: 10750995. Axial and coronal fat-suppressed proton density-weighted images demonstrate soft tissue edema surrounding the PTFJ with subtle irregularity of the posterior ligament (blue arrow) near the fibular attachment and an underlying bone contusion (arrowhead). Proximal Tibiofibular Joint Instability and Treatment Approaches: A Systematic Review of the Literature Authors: Bradley M. Kruckeberg Mayo Clinic - Rochester Mark Cinque Stanford Medicine. The forgotten joint: quantifying the anatomy of the proximal tibiofibular joint. Previous attempts to make it better provided only temporary relief. Axial fat-suppressed proton density-weighted images demonstrates a poorly defined chronically torn posterior PTFJ ligament (blue arrowhead). Plain radiographs should be taken from anteroposterior, lateral, and oblique (45 to 60 degrees internal rotation of the knee) views, with comparison views from the contralateral knee, or from the preinjury knee if possible. Epub 2018 Jul 23. 2023 Mar 13;18(1):196. doi: 10.1186/s13018-023-03684-x. Methods: The early recognition of instability in the proximal tibiofibular joint is necessary to optimize management of the injury and to avoid potential misdiagnosis. For the treatment of PTFJ instability, there were 18 studies (35 patients) describing nonoperative management, 3 studies (4 patients) reported on open reduction, 11 studies (25 patients) reported on fixation, 4 studies (10 patients) that described proximal fibula resection, 3 studies (11 patients) reported on adjustable cortical button repair, 2 studies (3 patients) reported on ligament reconstructions, and 5 (8 patients) studies reported on biceps femoris tendon rerouting. In acute anterolateral PTFJ dislocation without spontaneous dislocation or fracture, closed reduction is performed. The anterior tibiofibular ligament (green arrow) is edematous but in continuity. Proximal tibiofibular joint (PTFJ) instability is a rare knee injury, accounting for less than 1% of knee injuries. MRIs ability to directly inspect the PTFJ supporting ligaments and relevant adjacent anatomy allows accurate characterization of the often unexpected injuries to the PTFJ. doi: 10.2214/AJR.07.3406. Axial images from superior to inferior demonstrate soft tissue edema surrounding the proximal tibiofibular joint. The fracture was extremely difficult to visualize on radiographs. PMID: 20127312. Rev Chir Orthop Reparatrice Appar Mot. Reconstructive procedures are recommended for patients whose source of pain is instability in the joint as opposed to arthritis. There are two ways to initiate a consultation with Dr. LaPrade: You can providecurrentX-rays and/or MRIs for a clinical case review with Dr. LaPrade. It is common for patients to also have transient peroneal nerve injuries, especially with posteromedial dislocation.1,2. With the knee flexed 90 the fibular head may be subluxed/dislocated by gentle pressure in an anterior or posterior direction. The most (77% to 90%) PTFJ dislocations and instability were anterolateral/unspecified anterior dislocation or instability. Edina, MN 55435, EAGAN-VIKING LAKES OFFICE MRI evaluation of chronic instability is more challenging given the lack of associated soft tissue edema (Figure 11). April 25, 2013 - Appointment with Dr. Lyman, MD-Lyman Knee Clinic, Coeur D'Alene, ID. Ma W, Wang F, Sun S, Ding L, Wang L, Yu T, Zhang Y. J Orthop Surg Res. 48 year-old female with an acute PLC sprain and ACL tear. eCollection 2023 Jan. Mediterr J Rheumatol. Nate Kopydlowski and Jon K. Sekiya History and physical examination are very important for diagnosis. In general, reaming a tunnel from front to back (anterior to posterior) through the fibular head and having it exit where the proximal tibiofibular joint posterior ligaments attach, and then drilling another tunnel from front to back on the tibia and which exits posteriorly at the attachment site of the proximal posterior tibiofibular joint ligaments, is the desired location for an anatomic-based reconstruction graft. Treatment for proximal tibiofibular joint stability requires that nonsurgical management be attempted first for patients with atraumatic subluxation of the proximal tibiofibular joint. On the superior axial image, a small amount of fluid (arrowhead) in the fibular collateral ligament (FCL)-biceps femoris bursa delineates the relationship between the anterior arm of the long head of the biceps femoris tendon (orange arrows) and the FCL (yellow arrows). Epub 2010 Feb 3. The integrity of the proximal tibiofibular joint is best visualized through plain radiographs. In cases where the symptoms of proximal tibiofibular joint instability are difficult to discern, especially for chronic cases, we have found that taping of the proximal tibiofibular joint is helpful to confirm the diagnosis. On MRI, the tibiofibular ligaments are obliquely oriented and extend cephalad from the fibula to the tibia and therefore multiplanar evaluation is essential.10 The anterior ligament is more readily identified given that it is thicker than the posterior ligament. Anatomy of the proximal tibiofibular joint. The common peroneal nerve (CPN) is visualized and protected throughout the case. 1 The post-traumatic etiology is most frequently reported as that the initial trauma may be unnoticed and therefore absent in the clinical history. Early diagnosis of this injury can prevent further injuries to the joint that are harder to treat, such as chronic or fixed subluxation. Epub 2017 May 10. All nonsurgical therapies should be attempted before surgical intervention. 62.4 Clinical Signs of Proximal Tibiofibular Joint Instability. Am J Sports Med. eCollection 2022 Sep. Pappa E, Kakridonis F, Trantos IA, Ioannidis K, Koundis G, Kokoroghiannis C. Cureus. In most circumstances, it is the posterior proximal tibiofibular joint ligament that is injured. 2017 Jul;45(8):1888-1892. doi: 10.1177/0363546517697288. The posterior ligament attaches to the fibula medial to the styloid and inferomedial to the insertion of the popliteofibular ligament.11 The integrity of the FCL and biceps femoris tendons should also be evaluated as posterolateral corner injuries will often demonstrate soft tissue edema surrounding the joint without disruption of the proximal tibiofibular ligaments. The condition is often missed, and the true incidence is unknown. The TightRope needle is then passed through to the anteromedial aspect of the tibia until it exits the skin medially. All nonsurgical therapies should be attempted before surgical intervention. Proximal tibiofibular joint instability is a very unusual and uncommon condition. and transmitted securely. Most patient histories do not reveal any mechanism of injury to the proximal tibiofibular joint, and symptoms of lateral knee pain can be very misleading. ABSTRACT Ogden JA. Proximal Tibiofibular Joint (PTFJ):Stabilizing Tape Technique for Posterior Instability Learn How We Can Help You Stay Active Request a Consultation About the Author: Robert LaPrade, MD Robert LaPrade, MD, PhD has specialized skills and expertise in diagnosing and treating complicated knee injuries. Typically, the proximal tibiofibular joint is injured in a fall when the ankle is plantar-flexed, with the stress being brought through the fibula, will cause the proximal fibula to sublux (partial dislocation) out of place over the lateral aspect of the knee joint. More commonly, however, AP and lateral radiographs are performed (Figure 4). Both the anterior and posterior ligaments may be torn however the posterior ligament is weaker and more often torn (Figures 6-8). The arthrodesis procedure is recommended for patients in whom the correction of joint instability would not relieve pain, such as patients with proximal tibiofibular joint arthritis. Halbrecht JL, Jackson DW. Traumatic dislocations of the proximal tibiofibular joint are uncommon and are normally caused by high-energy injury or a fall on a twisted knee. Proximal tibiofibular joint instability is a very unusual and uncommon condition. Marchetti DC, Chahla J, Moatshe G, Slette EL, LaPrade RF. PMID: 4837931. 2010 Sep;19(5):409-14. doi: 10.1097/BPB.0b013e3283395f6f. Proximal tibiofibular ligamentous abnormalities were present in 100% of acute (< 6 months) and 85.7% of chronic (>6 months) instability cases who underwent MRI. Proximal tibiofibular (PTF) joint instability is a rare condition: only 96 cases have been reported in the published literature. Treatment is prompt closed reduction with unstable injuries requiring surgical pinning versus soft tissue reconstruction. Dr. La Prade had just moved to Vail and I was his 2nd patient @ The Steadman Clinic. The proximal tibiofibular joint ligaments both strengthen the joint and allow it to rotate and translate during ankle and knee motion. Clinical and Surgical Pearls 1991 Nov;20(11):957-60. Limit patients to passive flexion until 6 weeks to reduce the stress that is applied to the reconstructed ligaments (prevent biceps femoris from pulling on the fibular head). Evaluate the TCO of your PACS download >, 750 Old Hickory Blvd, Suite 1-260Brentwood, TN 37027, Focus on Musculoskeletal and Neurological MRI, https://radsource.us/posterolateral-corner-injury, Postoperative Hip MRI in Patients Treated for FAI, The Anterior Meniscofemoral Ligament of the Medial Meniscus. Soft tissue edema is present in the anterior (green arrow) and posterior (blue arrows) PTFJ ligaments. This site needs JavaScript to work properly. doi: 10.1016/j.eats.2017.09.003. The CPN (red arrowhead) is abnormally flattened with increased T2 signal. While the role of the fibula and the posterolateral corner (PLC) in maintaining knee stability has received widespread attention, the contribution of the proximal tibiofibular joint to knee stability is often overlooked and injuries may easily go unnoticed. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review. Reconstruction using the biceps femoris tendon16 and iliotibial band17 autograft have been detailed, and LaPrade has also described a technique to reconstruct solely the posterior ligaments (Figure 12).18,19 Reconstruction of the anterior and posterior ligaments utilizing hamstring grafts has been described by Kobbe et al.20 and Morrison et al.21 More recently, multiple technique papers have described PTFJ stabilization without reconstruction.22,23. When the knee is flexed beyond 30 degrees, relaxation of the FCL and biceps femoris tendons allows the fibula to shift anteriorly which reduces joint stability and allows the fibular head to move approximately 7-10 mm in the anteroposterior plane.6,7 In the event of an added twisting element, external rotation of the tibia pulls the fibula laterally and tension in the anterolateral compartment musculature then further draws the fibula anteriorly.8. Proximal Tibiofibular Joint Reconstruction With a Semitendinosus Allograft for Chronic Instability. 55 year-old female status-post fibular head dislocation with stable reduction but lateral-sided laxity. Patient History Fibular resection during an arthrodesis procedure can decrease ankle pain and instability after surgery. Nonoperative treatment is associated with persistent symptoms, whereas both fixation and fibular head resection are associated with high complication rates. Instability of this joint may be in the anterolateral, posteromedial, or superior directions. Anatomic reconstruction of chronic symptomatic anterolateral proximal tibiofibular joint instability. 31 year-old female status-post fall and twisting injury while skiing with lateral knee pain radiating down the calf. Atraumatic dislocation of the proximal tibiofibular joint is easily misdiagnosed when there is no clinical suspicion of the injury, owing to its association with a wide range of symptoms that mirror many common knee injuries. doi: 10.1016/j.eats.2022.08.052. Instability of the joint can be a result of an injury to these ligaments. Ogden 10 reported that 57% of patients with acute proximal tibiofibular dislocations required surgery for ongoing symptoms after treatment failure with closed reduction and 3 weeks of immobilization. Patients with subluxation of the proximal tibiofibular joint commonly report pain over the joint that is aggravated by direct pressure over the fibular head. Successful diagnosis of the injury can be improved by a better understanding of the biomechanics of the joint and a clinical suspicion of the injury when symptoms are present. Just below these structures, the posterior proximal tibiofibular ligament is inspected. Kerzner B, Mameri ES, Jackson GR, Casanova F, Boero I, Verdejo FG, Browning RB, Khan ZA, Dasari SP, Morgan VK, Chahla J. Arthrosc Tech. 2018 Feb 26;7(3):e271-e277. The fibular collateral ligament-biceps femoris bursa. You can schedule an office consultation with Dr. LaPrade. The reconstructive procedure is recommended for patients whose pain is a result of joint instability. A fibular bone bruise (asterisk) is present near the attachment of the posterior ligament. 2018 Apr;26(4):1096-1103. doi: 10.1007/s00167-017-4508-8. The integrity of the ankle and functional status of the peroneal nerve should also be assessed during the physical examination, because of the association of nerve, syndesmotic ligament, and interosseous membrane damage with this injury. Atraumatic proximal tibiofibular joint subluxation is the more common presentation of proximal tibiofibular joint instability. Displacement of the fibular head in relation to the tibiavisible or palpable deformity. 43 year-old male with lateral knee pain status-post snowboarding injury. The tibiofibular joints are a set of articulations that unite the tibia and fibula. Numerous disorders of the proximal tibiofibular joint can present as lateral knee pain. Recent traumatic anterolateral proximal tibiofibular joint dislocation. Management of Proximal Tibiofibular Instability MRI evaluation of recent injury will often reveal soft tissue edema both anterior and posterior to the joint, as well as within the ligaments. An injury to the proximal tibiofibular joint is rather rare, but can be debilitating in patients who have symptoms. 2016 May-Jun;40(3):470-6. doi: 10.1016/j.clinimag.2015.12.011. The proximal fibula moves posteromedial with knee extension. A chronically injured CPN may appear atrophic with abnormally increased T2 signal as well as an abnormal contour due to surrounding scar tissue which often effaces the normal perineural fat. During significant trauma, traumatic dislocations of the tibiofibular joint are commonly missed, so the physical examination of this joint is a significant part of the comprehensive knee examination. In acute cases, we have found that immobilization in a brace in full extension for 3 weeks is often very effective to allow the posterior proximal tibiofibular joint ligament tear to scar in sufficiently such that there is no instability. PMID: 20440223. 2022;8:8. doi: 10.1051/sicotj/2022008. PMID: 28339288. Particular attention is paid to the status of the menisci, patellofemoral tracking, cruciate ligaments, and presence of loose bodies as pathologies in these areas can mimic . Instability of this joint may be in the anterolateral, posteromedial, or superior directions. (Please keep reading below for more information on this condition.). The Proximal Tibiofibular Joint: A Biomechanical Analysis of the Anterior and Posterior Ligamentous Complexes. In acute cases, we have found that immobilization in a brace in full extension for 3 weeks is often very effective to allow the posterior proximal tibiofibular joint ligament tear to scar in sufficiently such that there is no instability. Proximal tibiofibular joint dislocation and instability is an easily overlooked cause of lateral knee pain. However, in chronic cases, immobilization would not be sufficient to achieve this goal. Okubo A, Kajikawa Y, Nakajima S, Watanabe N, Yotsumoto T, Oshima Y, Iizawa N, Majima T. SICOT J. Only gold members can continue reading. Patients with subluxation of the proximal tibiofibular joint commonly report pain over the joint that is aggravated by direct pressure over the fibular head. Dr. Robert F. LaPrade operated on my right knee in May of 2010. 2019. We recommend joint reconstruction to repair the proximal tibiofibular joint, which will retain the functional anatomy and rotation of the joint, over arthrodesis, especially in children and athletes. 3D renders demonstrate posterior proximal tibiofibular reconstruction using LaPrades technique (12A). The arthrodesis procedure is recommended for patients in whom the correction of joint instability would not relieve pain, such as patients with proximal tibiofibular joint arthritis. Concurrent surgical treatment of posterolateral corner (PLC) and PTFJ instability poses technical challenges due to the limited working space . Instability of the proximal tibiofibular joint (PTFJ) can present as frank dislocations, subtle symptoms of lateral knee pain, discomfort during activity, or symptoms related to irritation of the common peroneal nerve. The proximal tibiofibular joint ligaments both strengthen the joint and allow it to rotate and translate during ankle and knee motion. Before Furthermore, we excluded studies that did not report patient follow-up time and studies without any patient-reported, clinical or radiographic outcomes at the final follow-up. Nonoperative treatment is associated with persistent symptoms, whereas both fixation and fibular head resection are associated with high complication rates. Reconstructive procedures are recommended for patients whose source of pain is instability in the joint as opposed to arthritis. A variety of surgical treatments have been proposed over the last decades. Purpose: A more definitive way to validate a diagnosis of proximal tibiofibular joint instability is with a taping program of the joint. Clin Orthop Relat Res. The proximal tibiofibular joint ligaments both strengthen the joint and allow it to rotate and translate during ankle and knee motion. PMID: 16374587. Traumatic dislocations commonly cause pain along the lateral knee that radiates into the region of the iliotibial band and the patellofemoral joint and is increased with palpation of the prominent fibular head and ankle motion. Arthroscopy. The relative avascularity of the area of the proximal tibiofibular joint prevents the presentation of knee effusion with an isolated injury, but there may be a prominent lateral mass.1 Anterolateral dislocations often manifest with severe pain near the proximal tibiofibular joint and along the stretched biceps femoris tendon, which may appear to be a tense, curved cord.1 Dorsiflexing and everting the foot, as well as extending the knee, emphasize pain at the proximal tibiofibular joint. Sep 11, 2016 | Posted by admin in SPORT MEDICINE | Comments Off on Management of Proximal Tibiofibular Instability. The proximal tibiofibular joint is a synovial sliding joint which dissipates torsional forces applied at the ankle and tensile forces generated during lateral tibial bending moments.2 The joint is stabilized by multiple ligaments including the anterior and posterior tibiofibular ligaments as well as the fibular collateral ligament (FCL). PMID: 97965. Because the posterior ligament is thinner it is often more difficult to identify and best evaluated on axial and sagittal images just anterior to the popliteus musculotendinous unit (Figure 5). Concurrent with this, we will perform a Tinels test by percussing over the common peroneal nerve to confirm the presence of dysesthesias or zingers, which translate down the leg. The most common traumatic dislocations are in an anterolateral direction, followed by posteromedial and superior dislocations. Early diagnosis of this injury can prevent further injuries to the joint that are harder to treat, such as chronic or fixed subluxation. Arthrosc Tech. 1974 Jun;(101):186-91. In the past, while others have often treated this instability of this joint by fusing it, we have reported through research that a proximal posterior tibiofibular joint ligament reconstruction is easily performed, does not overconstrain the joint and has decreased the chance of leading to ankle pathology further down the line. Imaging Techniques Marchetti DC, Moatshe G, Phelps BM, Dahl KD, Ferrari MB, Chahla J, Turnbull TL, LaPrade RF. Zhongguo Gu Shang. Injuries to the joint are more commonly atraumatic and should be treated with surgery only after all other therapies have been exhausted.
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