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Review of Common Clinical Conditions of the Proximal Tibiofibular Joint

December 11, 2018 | Surgery
Christian M. Curatolo, BS ; Gregory Bach, MD ; Christopher E. Mutty, MD ; John M. Marzo, MD
Author and Disclosure Information

Mr. Curatolo is a medical student at The Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York. Dr. Mutty is Clinical Assistant Professor, Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York. Dr. Marzo is Clinical Professor, Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York. Dr. Bach is a resident, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida.

Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.

Address correspondence to: John Marzo, MD, The Jacobs School of Medicine and Biomedical Sciences, 955 Main St, Buffalo New York, 14203 (tel, 716-829-2982; fax, 716-829-3945; email jmmarzo@buffalo.edu).

Am J Orthop. 2018;47(12). Copyright Frontline Medical Communications Inc. 2018. All rights reserved.

Christian M. Curatolo, BS Gregory Bach, MD Christopher E. Mutty, MD John M. Marzo, MD . Review of Common Clinical Conditions of the Proximal Tibiofibular Joint. Am J Orthop. December 11, 2018

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.

ARTHRITIS

The management options for secondary arthritis due to chronic PTFJ instability have rarely been discussed in the literature. Arthrodesis or fibular head resection are options for the treatment of arthritis, and the above discussion applies here as well. Yaniv and colleagues40 describe a technical procedure for addressing both instability and secondary joint arthritis. The authors performed a ligament reconstruction of the PTFJ using the anterior part of the biceps femoris combined with interpositional joint arthroplasty using a vascularized fascia lata strip. Two weeks post-operation, the patient was walking with full weight-bearing and 6 weeks post-operation the first sports activities were allowed.40

CONCLUSION

Conditions affecting the PTFJ, their diagnosis, and treatment are infrequent topics of discussion in the literature. While PTFJ injury, instability, and other disease states are admittedly rare, clinicians need to include them in the differential diagnosis of patients presenting with lateral knee complaints. Diagnostic imaging is a critical component in early identification of PTFJ conditions to prevent long-term complications. Most injuries are treated first with conservative methods, reserving surgery as an option when first-line measures are unsuccessful. Advancements in surgical options for dislocation and subluxation/chronic instability of the joint have been made, but further research on their effectiveness and long-term outcomes is needed before a gold-standard treatment can be determined.

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