Morrison T.D., Shaer J.A., Little J.E. In order to best treat this pathology, Dr. LaPrade and his team have developed an anatomic proximal posterior tibiofibular joint reconstruction procedure. Ligament reconstruction using a semitendinosus tendon graft for proximal tibiofibular joint disorder: Case report. 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. Axial (8A), coronal (8B), and sagittal (8C) fat-suppressed proton density-weighted images. 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, 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), on Management of Proximal Tibiofibular Instability. On the AP radiograph, the fibula should overlap the lateral margin of the lateral tibial condyle and lateral displacement will widen the interosseous space. Bookshelf The vast majority of the time, the torn ligaments are the posterior proximal tibiofibular joint ligaments, so a graft which is placed in the anatomic position to restore these ligaments has been proven to be successful. Instability of this joint may be in the anterolateral, posteromedial, or superior directions. Acute injury to the common peroneal nerve (CPN) may manifest as nerve thickening and increased T2 signal consistent with edema and swelling. This is because there are no muscles that can control the joint for most activities of daily living. Am J Sports Med. Once a diagnosis of PTFJ instability is confirmed, a standard diagnostic arthroscopy is performed through 2 portals. April 25, 2013 - Appointment with Dr. Lyman, MD-Lyman Knee Clinic, Coeur D'Alene, ID. Injury to the proximal tibiofibular joint can lead to lateral knee pain and instability owing to chronic rupture of the posterior tibiofibular ligament. The PTFJ is also unstable on physical examination. Proximal Tibiofibular Joint Instability | SpringerLink Initial management of traumatic joint dislocation should involve closed reduction under local anesthesia, followed by surgical intervention if reduction fails. Proximal tibiofibular joint instability is a very unusual and uncommon condition. Epub 2017 Mar 21. Injuries to the joint are more commonly atraumatic and should be treated with surgery only after all other therapies have been exhausted. I can run, bike, & climb mountains. The integrity of the proximal tibiofibular joint is best visualized through plain radiographs. This results in the fibula rotating away from the tibia during deep squatting. 1978 Jul;131(1):133-8. doi: 10.2214/ajr.131.1.133. Soft tissue edema is present in the anterior (green arrow) and posterior (blue arrows) PTFJ ligaments. With the knee flexed 90 the fibular head may be subluxed/dislocated by gentle pressure in an anterior or posterior direction. Reconstructive procedures are recommended for patients whose source of pain is instability in the joint as opposed to arthritis. 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. Axial (7A) and coronal (7B) fat-suppressed proton density-weighted images demonstrate soft tissue edema at the PTFJ and a tear of the posterior ligament (blue arrows) near the fibular attachment. All nonsurgical therapies should be attempted before surgical intervention. Nate Kopydlowski and Jon K. Sekiya Patient History 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. Instability of the joint can be a result of an injury to these ligaments. Proximal tibiofibular ligament reconstruction, specifically biceps rerouting and anatomic graft reconstruction, leads to improved outcomes with low complication rates. Marchetti DC, Moatshe G, Phelps BM, Dahl KD, Ferrari MB, Chahla J, Turnbull TL, LaPrade RF. Patients with subluxation of the proximal tibiofibular joint commonly report pain over the joint that is aggravated by direct pressure over the fibular head. 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 diagnosis of joint instability can be confirmed by steroid and local anesthetic injection into the joint under fluoroscopic guidance, if pain is relieved.
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