Article

Review of Common Clinical Conditions of the Proximal Tibiofibular Joint

Publish date: December 11, 2018

Christian M. Curatolo, BS

Gregory Bach, MD

Christopher E. Mutty, MD

John M. Marzo, MD

TAKE-HOME POINTS

Problems of the proximal tibiofibular joint (PFTJ) should be considered in the differential diagnosis when a patient presents with complaints in the lateral aspect of the knee.
The primary function of the PTFJ is to transmit and absorb axial loads from weight bearing on the extremity, and to dissipate torsional loads applied to the leg and ankle.
The most common instability pattern is anterolateral fibular displacement.
Most proximal tibiofibular joint instabilities can be treated with closed reduction and conservative care, but some require internal fixation or soft-tissue reconstruction.
Arthritic conditions of the PTFJ are treated similar to those of any diarthrodial joint, with additional option of surgical arthrodesis or resection arthroplasty.

References

Ogden JA. The anatomy and function of the proximal tibiofibular joint. Clin Orthop Relat Res. 1974(101):186-191.
Resnick D, Newell JD, Guerra J, Jr., Danzig LA, Niwayama G, Goergen TG. Proximal tibiofibular joint: anatomic-pathologic-radiographic correlation. AJR Am J Rroentgenol. 1978;131(1):133-138. doi: 10.2214/ajr.131.1.133.
See A, Bear RR, Owens BD. Anatomic mapping for surgical reconstruction of the proximal tibiofibular ligaments. Orthopedics. 2013;36(1):e58-63. doi: 10.3928/01477447-20121217-19.
Ogden JA. Subluxation of the proximal tibiofibular joint. Clin Orthop Relat Res. 1974(101):192-197. doi: 10.2106/00004623-197456010-00015
Bozkurt M, Yilmaz E, Akseki D, Havitcioglu H, Gunal I. The evaluation of the proximal tibiofibular joint for patients with lateral knee pain. Knee. 2004;11(4):307-312. doi: 10.1016/j.knee.2003.08.006
Dirim B, Wangwinyuvirat M, Frank A, et al. Communication between the proximal tibiofibular joint and knee via the subpopliteal recess: MR arthrography with histologic correlation and stratigraphic dissection. AJR Am J Roentgenol. 2008;191(2):W44-W51. doi: 10.2214/AJR.07.3406.
Eichenblat M, Nathan H. The proximal tibio fibular joint. An anatomical study with clinical and pathological considerations. Int Orthop. 1983;7(1):31-39. doi: 10.1007/bf00267557
Espregueira-Mendes JD, da Silva MV. Anatomy of the proximal tibiofibular joint. Knee Surg Sports Traumatol Arthrosc. 2006;14(3):241-249. doi: 10.1007/s00167-005-0684-z.
Scott J, Lee H, Barsoum W, van den Bogert AJ. The effect of tibiofemoral loading on proximal tibiofibular joint motion. J Anat. 2007;211(5):647-653. doi: 10.1111/j.1469-7580.2007.00803.x.
Ogden JA. Subluxation and dislocation of the proximal tibiofibular joint. J Bone Joint Surg Am. 1974;56(1):145-154. doi: 10.2106/00004623-197456010-00015
Sekiya JK, Kuhn JE. Instability of the proximal tibiofibular joint. J Am Acad Orthop Surg. 2003;11(2):120-128. doi: 10.5435/00124635-200303000-00006
Horan J, Quin G. Proximal tibiofibular dislocation. Emerg Med Jl : EMJ. 2006;23(5):e33. doi: 10.1136/emj.2005.032144.
Semonian RH, Denlinger PM, Duggan RJ. Proximal tibiofibular subluxation relationship to lateral knee pain: a review of proximal tibiofibular joint pathologies. J Orthop Sports Phys Ther. 1995;21(5):248-257. doi: 10.2519/jospt.1995.21.5.248.
Veth RP, Kingma LM, Nielsen HK. The abnormal proximal tibiofibular joint. Arch Orthop Trauma Surg. 1984;102(3):167-171. doi: 10.1007/bf00575227
Boya H, Ozcan O, Oztekin HH. Radiological evaluation of the proximal tibiofibular joint in knees with severe primary osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2008;16(2):157-159. doi: 10.1007/s00167-007-0442-5.
Öztuna V, Yildiz A, Özer C, Milcan A, Kuyurtar F, Turgut A. Involvement of the proximal tibiofibular joint in osteoarthritis of the knee. The Knee. 2003;10(4):347-349. doi: 10.1016/s0968-0160(03)00004-8
Milankov M, Kecojević V, Gvozdenović N, Obradović M. Dislocation of the proximal tibiofibular joint. Med Pregl. 2013;66(9-10):387-391. doi: 10.2298/mpns1310387m
Sijbrandij S. Instability of the proximal tibio-fibular joint. Acta Orthop Scand. 1978;49(6):621-626. doi: 10.3109/17453677808993250
Aladin A, Lam KS, Szypryt EP. The importance of early diagnosis in the management of proximal tibiofibular dislocation: a 9- and 5-year follow-up of a bilateral case. Knee. 2002;9(3):233-236. doi: 10.1016/S0968-0160(02)00012-1
Turco VJ, Spinella AJ. Anterolateral dislocation of the head of the fibula in sports. Am J Sports Med. 1985;13(4):209-215. doi: 10.1177/036354658501300401.
Hey HW, Ng LW, Ng YH, Sng WZ, Manohara R, Thambiah JS. Radiographical definition of the proximal tibiofibular joint - A cross-sectional study of 2984 knees and literature review. Injury. 2016;47(6):1276-1281. doi: 10.1016/j.injury.2016.01.035.
Voglino JA, Denton JR. Acute traumatic proximal tibiofibular joint dislocation confirmed by computed tomography. Orthopedics. 1999;22(2):255-258.
Burke CJ, Grimm LJ, Boyle MJ, Moorman CT, 3rd, Hash TW, 2nd. Imaging of Proximal Tibiofibular Joint Instability: A 10 year retrospective case series. Clin Imaging. 2016;40(3):470-476. doi: 10.1016/j.clinimag.2015.12.011.
Parkes JC II, Zelko RR. Isolated acute dislocation of the proximal tibiofibular joint. Case report. J Bone Joint Surg Am. 1973;55(1):177-183. Doi: 10.2106/00004623-197355010-00019
Gvozdenović N, Gvozdenović K, Obradović M, Stanković M. Modified technique of the treatment for proximal tibiofibular joint dislocation. Vojnosanitetski Pregled. 2017;74(3):282-286. doi: 10.2298/VSP150318177G
van den Bekerom MP, Weir A, van der Flier RE. Surgical stabilisation of the proximal tibiofibular joint using temporary fixation: a technical note. Acta Orthop Belg. 2004;70(6):604-608.
Calabró T, Cevolani L, Chehrassan M, Gasbarrini A. A new technique of reduction for isolated proximal tibiofibular joint dislocation: a case report. Eur Rev Med Pharmacol Sci. 2014;18(1):93-95.
Camarda L, Abruzzese A, D'Arienzo M. Proximal tibiofibular joint reconstruction with autogenous semitendinosus tendon graft. Tech Orthop. 2013;28(3):269-272. doi. 10.1097/BTO.0b013e31827b7182
Herzog GA, Serrano-Riera R, Sagi HC. Traumatic Proximal Tibiofibular Dislocation: A Marker of Severely Traumatized Extremities. J Orthop Trauma. 2015;29(10):456-459. doi: 10.1097/BOT.0000000000000348.
Haupt S, Frima H, Sommer C. Proximal tibiofibular joint dislocation associated with tibial shaft fractures - 7 cases. Injury. 2016;47(4):950-953. doi: 10.1016/j.injury.2016.01.037.
Warner BT, Moulton SG, Cram TR, LaPrade RF. Anatomic Reconstruction of the Proximal Tibiofibular Joint. Arthrosc Tech. 2016;5(1):e207-e210. doi: 10.1016/j.eats.2015.11.004
Giachino AA. Recurrent dislocations of the proximal tibiofibular joint. Report of two cases. J Bone Joint Surg Am. 1986;68(7):1104-1106. doi: 10.2106/00004623-198668070-00023
Shapiro GS, Fanton GS, Dillingham MF. Reconstruction for recurrent dislocation of the proximal tibiofibular joint. A new technique. Orthop Rev. 1993;22(11):1229-1232.
Mena H, Brautigan B, Johnson DL. Split biceps femoris tendon reconstruction for proximal tibiofibular joint instability. Arthroscopy. 2001;17(6):668-671. doi: 10.1053/jars.2001.22359.
Miller T. New technique of soft tissue reconstruction for proximal tibiofibular joint instability using iliotibial band and biceps femoris longhead autograft. Tech Orthop. 2014;29(4):243-247. doi: 10.1097/BTO.0000000000000046
Kobbe P, Flohe S, Wellmann M, Russe K. Stabilization of chronic proximal tibiofibular joint instability with a semitendinosus graft. Acta Orthop Belg. 2010;76(6):830-833.
Maffulli N, Spiezia F, Oliva F, Testa V, Capasso G, Denaro V. Gracilis autograft for recurrent posttraumatic instability of the superior tibiofibular joint. Am J Sports Med. 2010;38(11):2294-2298. doi: 10.1177/0363546510373472.
Morrison TD, Shaer JA, Little JE. Bilateral, atraumatic, proximal tibiofibular joint instability. Orthopedics. 2011;34(2):133. doi: 10.3928/01477447-20101221-28.
Horst PK, LaPrade RF. Anatomic reconstruction of chronic symptomatic anterolateral proximal tibiofibular joint instability. Knee Surg Sports Traumatol Arthrosc. 2010;18(11):1452-1455. doi: 10.1007/s00167-010-1049-9.
Yaniv M, Koenig U, Imhoff AB. A technical solution for secondary arthritis due to chronic proximal tibiofibular joint instability. Knee Surg Sports Traumatol Arthrosc. 1999;7(5):334-336. doi: 10.1007/s001670050173.

References

Ogden JA. The anatomy and function of the proximal tibiofibular joint. Clin Orthop Relat Res. 1974(101):186-191.
Resnick D, Newell JD, Guerra J, Jr., Danzig LA, Niwayama G, Goergen TG. Proximal tibiofibular joint: anatomic-pathologic-radiographic correlation. AJR Am J Rroentgenol. 1978;131(1):133-138. doi: 10.2214/ajr.131.1.133.
See A, Bear RR, Owens BD. Anatomic mapping for surgical reconstruction of the proximal tibiofibular ligaments. Orthopedics. 2013;36(1):e58-63. doi: 10.3928/01477447-20121217-19.
Ogden JA. Subluxation of the proximal tibiofibular joint. Clin Orthop Relat Res. 1974(101):192-197. doi: 10.2106/00004623-197456010-00015
Bozkurt M, Yilmaz E, Akseki D, Havitcioglu H, Gunal I. The evaluation of the proximal tibiofibular joint for patients with lateral knee pain. Knee. 2004;11(4):307-312. doi: 10.1016/j.knee.2003.08.006
Dirim B, Wangwinyuvirat M, Frank A, et al. Communication between the proximal tibiofibular joint and knee via the subpopliteal recess: MR arthrography with histologic correlation and stratigraphic dissection. AJR Am J Roentgenol. 2008;191(2):W44-W51. doi: 10.2214/AJR.07.3406.
Eichenblat M, Nathan H. The proximal tibio fibular joint. An anatomical study with clinical and pathological considerations. Int Orthop. 1983;7(1):31-39. doi: 10.1007/bf00267557
Espregueira-Mendes JD, da Silva MV. Anatomy of the proximal tibiofibular joint. Knee Surg Sports Traumatol Arthrosc. 2006;14(3):241-249. doi: 10.1007/s00167-005-0684-z.
Scott J, Lee H, Barsoum W, van den Bogert AJ. The effect of tibiofemoral loading on proximal tibiofibular joint motion. J Anat. 2007;211(5):647-653. doi: 10.1111/j.1469-7580.2007.00803.x.
Ogden JA. Subluxation and dislocation of the proximal tibiofibular joint. J Bone Joint Surg Am. 1974;56(1):145-154. doi: 10.2106/00004623-197456010-00015
Sekiya JK, Kuhn JE. Instability of the proximal tibiofibular joint. J Am Acad Orthop Surg. 2003;11(2):120-128. doi: 10.5435/00124635-200303000-00006
Horan J, Quin G. Proximal tibiofibular dislocation. Emerg Med Jl : EMJ. 2006;23(5):e33. doi: 10.1136/emj.2005.032144.
Semonian RH, Denlinger PM, Duggan RJ. Proximal tibiofibular subluxation relationship to lateral knee pain: a review of proximal tibiofibular joint pathologies. J Orthop Sports Phys Ther. 1995;21(5):248-257. doi: 10.2519/jospt.1995.21.5.248.
Veth RP, Kingma LM, Nielsen HK. The abnormal proximal tibiofibular joint. Arch Orthop Trauma Surg. 1984;102(3):167-171. doi: 10.1007/bf00575227
Boya H, Ozcan O, Oztekin HH. Radiological evaluation of the proximal tibiofibular joint in knees with severe primary osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2008;16(2):157-159. doi: 10.1007/s00167-007-0442-5.
Öztuna V, Yildiz A, Özer C, Milcan A, Kuyurtar F, Turgut A. Involvement of the proximal tibiofibular joint in osteoarthritis of the knee. The Knee. 2003;10(4):347-349. doi: 10.1016/s0968-0160(03)00004-8
Milankov M, Kecojević V, Gvozdenović N, Obradović M. Dislocation of the proximal tibiofibular joint. Med Pregl. 2013;66(9-10):387-391. doi: 10.2298/mpns1310387m
Sijbrandij S. Instability of the proximal tibio-fibular joint. Acta Orthop Scand. 1978;49(6):621-626. doi: 10.3109/17453677808993250
Aladin A, Lam KS, Szypryt EP. The importance of early diagnosis in the management of proximal tibiofibular dislocation: a 9- and 5-year follow-up of a bilateral case. Knee. 2002;9(3):233-236. doi: 10.1016/S0968-0160(02)00012-1
Turco VJ, Spinella AJ. Anterolateral dislocation of the head of the fibula in sports. Am J Sports Med. 1985;13(4):209-215. doi: 10.1177/036354658501300401.
Hey HW, Ng LW, Ng YH, Sng WZ, Manohara R, Thambiah JS. Radiographical definition of the proximal tibiofibular joint - A cross-sectional study of 2984 knees and literature review. Injury. 2016;47(6):1276-1281. doi: 10.1016/j.injury.2016.01.035.
Voglino JA, Denton JR. Acute traumatic proximal tibiofibular joint dislocation confirmed by computed tomography. Orthopedics. 1999;22(2):255-258.
Burke CJ, Grimm LJ, Boyle MJ, Moorman CT, 3rd, Hash TW, 2nd. Imaging of Proximal Tibiofibular Joint Instability: A 10 year retrospective case series. Clin Imaging. 2016;40(3):470-476. doi: 10.1016/j.clinimag.2015.12.011.
Parkes JC II, Zelko RR. Isolated acute dislocation of the proximal tibiofibular joint. Case report. J Bone Joint Surg Am. 1973;55(1):177-183. Doi: 10.2106/00004623-197355010-00019
Gvozdenović N, Gvozdenović K, Obradović M, Stanković M. Modified technique of the treatment for proximal tibiofibular joint dislocation. Vojnosanitetski Pregled. 2017;74(3):282-286. doi: 10.2298/VSP150318177G
van den Bekerom MP, Weir A, van der Flier RE. Surgical stabilisation of the proximal tibiofibular joint using temporary fixation: a technical note. Acta Orthop Belg. 2004;70(6):604-608.
Calabró T, Cevolani L, Chehrassan M, Gasbarrini A. A new technique of reduction for isolated proximal tibiofibular joint dislocation: a case report. Eur Rev Med Pharmacol Sci. 2014;18(1):93-95.
Camarda L, Abruzzese A, D'Arienzo M. Proximal tibiofibular joint reconstruction with autogenous semitendinosus tendon graft. Tech Orthop. 2013;28(3):269-272. doi. 10.1097/BTO.0b013e31827b7182
Herzog GA, Serrano-Riera R, Sagi HC. Traumatic Proximal Tibiofibular Dislocation: A Marker of Severely Traumatized Extremities. J Orthop Trauma. 2015;29(10):456-459. doi: 10.1097/BOT.0000000000000348.
Haupt S, Frima H, Sommer C. Proximal tibiofibular joint dislocation associated with tibial shaft fractures - 7 cases. Injury. 2016;47(4):950-953. doi: 10.1016/j.injury.2016.01.037.
Warner BT, Moulton SG, Cram TR, LaPrade RF. Anatomic Reconstruction of the Proximal Tibiofibular Joint. Arthrosc Tech. 2016;5(1):e207-e210. doi: 10.1016/j.eats.2015.11.004
Giachino AA. Recurrent dislocations of the proximal tibiofibular joint. Report of two cases. J Bone Joint Surg Am. 1986;68(7):1104-1106. doi: 10.2106/00004623-198668070-00023
Shapiro GS, Fanton GS, Dillingham MF. Reconstruction for recurrent dislocation of the proximal tibiofibular joint. A new technique. Orthop Rev. 1993;22(11):1229-1232.
Mena H, Brautigan B, Johnson DL. Split biceps femoris tendon reconstruction for proximal tibiofibular joint instability. Arthroscopy. 2001;17(6):668-671. doi: 10.1053/jars.2001.22359.
Miller T. New technique of soft tissue reconstruction for proximal tibiofibular joint instability using iliotibial band and biceps femoris longhead autograft. Tech Orthop. 2014;29(4):243-247. doi: 10.1097/BTO.0000000000000046
Kobbe P, Flohe S, Wellmann M, Russe K. Stabilization of chronic proximal tibiofibular joint instability with a semitendinosus graft. Acta Orthop Belg. 2010;76(6):830-833.
Maffulli N, Spiezia F, Oliva F, Testa V, Capasso G, Denaro V. Gracilis autograft for recurrent posttraumatic instability of the superior tibiofibular joint. Am J Sports Med. 2010;38(11):2294-2298. doi: 10.1177/0363546510373472.
Morrison TD, Shaer JA, Little JE. Bilateral, atraumatic, proximal tibiofibular joint instability. Orthopedics. 2011;34(2):133. doi: 10.3928/01477447-20101221-28.
Horst PK, LaPrade RF. Anatomic reconstruction of chronic symptomatic anterolateral proximal tibiofibular joint instability. Knee Surg Sports Traumatol Arthrosc. 2010;18(11):1452-1455. doi: 10.1007/s00167-010-1049-9.
Yaniv M, Koenig U, Imhoff AB. A technical solution for secondary arthritis due to chronic proximal tibiofibular joint instability. Knee Surg Sports Traumatol Arthrosc. 1999;7(5):334-336. doi: 10.1007/s001670050173.

Review of Common Clinical Conditions of the Proximal Tibiofibular Joint

TAKE-HOME POINTS

References

ABSTRACT

Pages

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