The tibiofibular joints are a set of articulations that unite the tibia and fibula. All nonsurgical therapies should be attempted before surgical intervention. Physical Examination Techniques PMID: 9240975. 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. The proximal tibiofibular joint should be palpated for tenderness, and laxity should be evaluated by translating the fibular head anteriorly and posteriorly with the thumb and index finger and asking the patient if the symptoms are reproduced or if there is any apprehension.4 The stability of the proximal tibiofibular joint is typically increased by full extension of the knee; if it is not, the lateral collateral ligament and posterolateral structures may also be injured. 2014 Sep;472(9):2691-7. doi: 10.1007/s11999-014-3574-1. ABSTRACT Instability of the joint can be a result of an injury to these ligaments. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Related 2010 Sep;19(5):409-14. doi: 10.1097/BPB.0b013e3283395f6f. History and physical examination are very important for diagnosis. 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. Nate Kopydlowski and Jon K. Sekiya 1974 Jun;(101):192-7. Acute injury to the common peroneal nerve (CPN) may manifest as nerve thickening and increased T2 signal consistent with edema and swelling. Thank you for choosing Dr. LaPrade as your healthcare provider. 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. Horst PK, LaPrade RF. Resecting and protecting the peroneal nerve during surgery can prevent peroneal nerve palsy. Knee Surgery, Sports Traumatology, Arthroscopy, 18(11), 1452-1455 . Comparison with the contralateral knee is useful to determine adequate tightness. On the AP radiographs the right knee demonstrates decreased overlap between the fibular head and the lateral tibial condyle compared with the left indicating that the fibular head is displaced laterally. It is important to compare the injured side to the normal contralateral side because some patients may have physiologic laxity of this joint. A Primer and Practical Guide to the Diagnosis of Joint Pain and Inflammation. Proximal tibiofibular joint instability is a very unusual and uncommon condition. 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.5 When a diagnosis is suspected but not clearly established by plain radiographs, axial computed tomography has been found to be the most accurate imaging modality for detection of injury of the proximal tibiofibular joint.6 Magnetic resonance imaging (MRI) can also confirm a diagnosis of recent dislocation, based on the presence of pericapsular edema of the joint and edema of the soleus at its fibular origin of the popliteus muscle, but this finding is often absent in chronic and atraumatic cases.7 Nonoperative treatment is associated with persistent symptoms, whereas both fixation and fibular head resection are associated with high complication rates. Early diagnosis of this injury can prevent further injuries to the joint that are harder to treat, such as chronic or fixed subluxation. Rule out lateral meniscus tear. 1974 Jun;(101):186-91. R. F. (2010). Reconstructive procedures are recommended for patients whose source of pain is instability in the joint as opposed to arthritis. Halbrecht JL, Jackson DW. Proximal tibiofibular joint dislocation and instability is an easily overlooked cause of lateral knee pain. It is common for patients to also have transient peroneal nerve injuries, especially with posteromedial dislocation.1,2. The CPN (red arrowhead) is abnormally flattened with increased T2 signal. Anatomic reconstruction of chronic symptomatic anterolateral proximal tibiofibular joint instability. The early recognition of instability in the proximal tibiofibular joint is necessary to optimize management of the injury and to avoid potential misdiagnosis. A disruption of these ligaments is generally traumatic and could produce an abnormal . Reconstructive procedures are recommended for patients whose source of pain is instability in the joint as opposed to arthritis. Methods such as arthrodesis and fibular head resection have largely been replaced with various . Protection of the peroneal nerve during surgery helps to prevent injury and relieves symptoms common to this injury. 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). Sep 11, 2016 | Posted by admin in SPORT MEDICINE | Comments Off on Management of Proximal Tibiofibular Instability. 48 year-old female with an acute PLC sprain and ACL tear. The proximal tibiofibular joint ligaments both strengthen the joint and allow it to rotate and translate during ankle and knee motion. Anterolateral dislocation commonly stems from injury to the anterior and posterior capsular ligaments, and commonly the lateral collateral ligament. You can schedule an office consultation with Dr. LaPrade. However, on a true lateral radiograph, the fibular head should intersect a line created by the posteromedial portion of the lateral tibial condyle and anterior or posterior displacement of the fibular head will disrupt this relationship.9 In cases of transient traumatic dislocation, anatomic alignment may be within normal limits and therefore normal radiographic alignment does not exclude the possibility of recent dislocation or instability. Bilateral, atraumatic, proximal tibiofibular joint instability. Is stability of the proximal tibiofibular joint important in the multiligament-injured knee? What are the findings? Evaluation of the joint, the supporting ligaments, and the common peroneal nerve should be assessed alongside evaluation of the posterolateral corner. Epub 2022 Apr 1. Proximal tibiofibular joint (PTFJ) instability can be easily missed or confused for other, more common lateral knee pathologies such as meniscal tears, fibular collateral ligament injury, biceps femoris pathology, or iliotibial band syndrome. Epub 2018 Jul 23. Proximal tibiofibular ligament reconstruction, specifically biceps rerouting and anatomic graft reconstruction, leads to improved outcomes with low complication rates. The proximal tibiofibular joint (PTFJ) is the articulation of the lateral tibial plateau of the tibia and the head of the fibula. 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. Chronic instability is commonly the result of untreated or misdiagnosed subluxation of the PTFJ. The integrity of the proximal tibiofibular joint is best visualized through plain radiographs. Proximal Tibiofibular Joint Instability and Treatment Approaches: A Systematic Review of the Literature Authors: Bradley M. Kruckeberg Mayo Clinic - Rochester Mark Cinque Stanford Medicine. This results in the fibula rotating away from the tibia during deep squatting. All other clinical possibilities should be ruled out before a diagnosis is made. 2017 Jul;45(8):1888-1892. doi: 10.1177/0363546517697288. 2023 Mar 13;18(1):196. doi: 10.1186/s13018-023-03684-x. Imaging Techniques Most commonly, hamstring allografts and autografts are used to reconstruct the proximal tibiofibular joint anatomically. 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) Chapter Synopsis Purpose: Disclaimer. It often appears striated due to the presence of multiple bundles, and it is located just caudal to the anterior arm of the short head of the biceps femoris tendon. Inclusion criteria were as follows: PTFJ instability treatment techniques, PTFJ surgical outcomes, English language, and human studies. Before Anterolateral dislocation commonly stems from injury to the anterior and posterior capsular ligaments, and commonly the lateral collateral ligament.1,2 The common cause of traumatic anterolateral dislocation is a fall on a flexed knee, or a violent twisting motion during an athletic activity.3 The hyperflexed knee results in relaxation of the biceps femoris tendon and the lateral collateral ligament, and the violent twisting of the body creates a torque that pushes the fibular head laterally to the edge of the lateral tibial metaphysis.1,2 The forced plantar flexion and ankle inversion forces the laterally displaced fibular head anteriorly.1 Epub 2016 Jan 16. Fibular resection during an arthrodesis procedure can decrease ankle pain and instability after surgery. Instability of the proximal tibiofibular joint is a very rare condition that is often misdiagnosed when there is no suspicion of the injury. Reconstruction is recommended to maintain correct anatomic function and rotation of the joint. While it is often difficult to identify a complete tear, in the absence of a history of dislocation or instability, edema in the ligaments associated with a fibular bone bruise along the posterior ligament attachment should raise awareness of recent traumatic injury. The surgical treatment for proximal tibiofibular joint instability most often consists of an anatomic reconstruction of the torn ligaments. The most common traumatic dislocations are in an anterolateral direction, followed by posteromedial and superior dislocations. A more definitive way to validate a diagnosis of proximal tibiofibular joint instability is with a taping program of the joint. 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. 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. A closed reduction should be attempted in patients with acute dislocation. Report of two cases. All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. For the case discussed in Figure 9 above, stabilization with an adjustable loop cortical fixation device was selected for multiple reasons.

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