Review of Common Clinical Conditions of the Proximal Tibiofibular Joint
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.
Clinical conditions of the proximal tibiofibular joint (PTFJ) are an uncommon source of lateral knee complaints and are often overlooked in the differential diagnosis as a source of the knee complaint. The most common conditions of the PTFJ include traumatic dislocations, fractures, chronic instability, and osteoarthritis. This article reviews the most common diseases affecting this joint and discusses both diagnostic and treatment strategies in an attempt to raise awareness of this joint as a source of lateral knee complaints.
ANATOMY
The PTFJ is an arthrodial synovial joint between the posterolateral surface of the tibia and the proximal fibular head.1 Surrounding the synovial membrane of the articulation is a fibrous joint capsule with distinct anterior and posterior tibiofibular ligaments.2,3 The anterior tibiofibular ligament has been described as 1 or 2 bands whereas the posterior ligament consists of 1 band.3 The anterior ligament attaches anteroinferiorly to the fibular styloid and posteriorly to Gerdy’s tubercle on the tibia. It runs linearly from posterior to anterior, and the fibular footprint is immediately anterior to the insertion of the biceps femoris. The posterior ligament is located inferior to the lateral joint space, and the fibular footprint is posterior to the insertion of the biceps femoris.3 Anatomy of the PTFJ is shown schematically in Figure 1.
Both the lateral collateral ligament (LCL) and the tibiofibular interosseous membrane add stability to the PTFJ. The LCL travels from the lateral femoral epicondyle to the lateral side of fibula head, anterior to the fibular styloid. The interosseous membrane extends obliquely between the borders of the tibia and fibula. Additionally, the short head of the biceps femoris, fibular collateral ligament, fabellofibular ligament, popliteofibular ligament, and popliteus muscle all attach to the PTFJ and provide additional stability to the joint.
It is important to note that the common peroneal nerve passes posteriorly over the fibula neck, can be involved in the clinical presentation, and is a potential source of concern with any injury to or surgery on the joint.4
Many studies have demonstrated that a communication with the tibiofemoral joint exists through the subpopliteal recess, but the rate of communication has varied widely.5-8 Most recently, Bozkurt and colleagues5 found the rate of communication between the PTFJ and lateral femorotibial space to be 57.9%. When distinct communication exists, the PTFJ must be considered as a fourth compartment of the knee and is subject to any process that affects the knee joint proper.
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