It is important to compare the injured side to the normal contralateral side because some patients may have physiologic laxity of this joint. Chapter Synopsis Suspicion of atraumatic injury to the proximal tibiofibular joint warrants extensive inspection during the physical examination of the knee. All nonsurgical therapies should be attempted before surgical intervention. Anavian J, Marchetti DC, Moatshe G, Slette EL, Chahla J, Brady AW, Civitarese DM, LaPrade RF. The reconstructive procedure is recommended for patients whose pain is a result of joint instability. Unable to load your collection due to an error, Unable to load your delegates due to an error. PMID: 9240975. A disruption of these ligaments is generally traumatic and could produce an abnormal . Instability of the proximal tibiofibular joint occurs when the ligaments which provide stability to this joint are injured. 1 The TFJ is stabilized by 3 broad ligaments forming a fibrous capsule, 3 2 posterior proximal tibiofibular ligament and 1 stronger anterior tibiofibular ligament. On the AP radiograph, the fibula should overlap the lateral margin of the lateral tibial condyle and lateral displacement will widen the interosseous space. Most patients are cleared to begin full activities between four to six months postoperatively, assuming they have adequate restoration of proximal tibiofibular joint stability, pain relief, and return of strength, agility and endurance. Subluxation of the proximal tibiofibular joint. EDINA- CROSSTOWN OFFICE While the role of the fibula and the posterolateral corner (PLC) in maintaining knee stability has received widespread attention, the contribution of the proximal tibiofibular joint to knee stability is often overlooked and injuries may easily go unnoticed. The fracture was extremely difficult to visualize on radiographs. Treatment is prompt closed reduction with unstable injuries requiring surgical pinning versus soft tissue reconstruction. The condition is often missed, and the true incidence is unknown. Atraumatic instability is more common and often misdiagnosed. A fibular bone bruise (asterisk) is present near the attachment of the posterior ligament. 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. An official website of the United States government. The most common traumatic dislocations are in an anterolateral direction, followed by posteromedial and superior dislocations. Log In or Register to continue PMID: 97965. MRI evaluation of chronic instability is more challenging given the lack of associated soft tissue edema (Figure 11). The diagnosis is often unknown and delayed due to its variable and . Improved outcomes after all forms of PTFJ instability treatment were reported; however, high complication rates were associated with both PTFJ fixation (28%) and fibular head resection (20%). The posterior ligament (blue arrow) is edematous, the midportion of the ligament is abnormally thinned on the axial, coronal, and sagittal images, and the tibial insertion is torn on the posterior-most coronal image. Oksum M, Randsborg PH. However, I will always be thankful to Dr. Shirzad for at least examining my proximal tib-fib joint and his supportive chart note acknowledging the pain upon palpation. In more chronic cases, we have the patient squat down, which can often demonstrate that the proximal tibiofibular joint is being subluxed. Proximal Tibiofibular Joint Injuries - Discussion: - function of the PTFJ - accept 1/6 the axial load of the leg - resist torsional stresses originating from the ankle - resist tensile forces created with weight bearing - resists lateral bending forces - subluxation is common in preadolescent females and resolves with skeletal maturity CHRONIC INSTABILITY. 13C: Preoperative physical exam video demonstrating gross PTFJ instability (13A), intra-operative physical exam video demonstrating resolution of instability following PTFJ reconstruction utilizing suture button with TightRope fixation (13B), and an AP postoperative radiograph demonstrating restoration of anatomic alignment (compare with preoperative radiograph Figure 4). Injury to the proximal tibiofibular joint is typically seen in athletes whose sports require violent twisting motions of the flexed knee. The chief function of the proximal tibiofibular joint is to dissipate some of the forces on the lower leg such as torsional stresses on the ankle, lateral tibial bending movements, and tensile weight bearing. Disclaimer. Zhongguo Gu Shang. The diagnosis of joint instability can be confirmed by steroid and local anesthetic injection into the joint under fluoroscopic guidance, if pain is relieved. Initial management of traumatic joint dislocation should involve closed reduction under local anesthesia, followed by surgical intervention if reduction fails. The arthrodesis procedure is recommended for patients in whom the correction of joint instability would not relieve pain, such as patients with proximal tibiofibular joint arthritis. Giachino A.A. Recurrent dislocations of the proximal tibiofibular joint. Injury to the proximal tibiofibular joint can lead to lateral knee pain and instability owing to chronic rupture of the posterior tibiofibular ligament. For the treatment of PTFJ instability, there were 18 studies (35 patients) describing nonoperative management, 3 studies (4 patients) reported on open reduction, 11 studies (25 patients) reported on fixation, 4 studies (10 patients) that described proximal fibula resection, 3 studies (11 patients) reported on adjustable cortical button repair, 2 studies (3 patients) reported on ligament reconstructions, and 5 (8 patients) studies reported on biceps femoris tendon rerouting. 1997 Jul-Aug;25(4):439-43. doi: 10.1177/036354659702500404. Hey - if he is good enough for Olympic and professional athletes..he's good enough for me! In order to best treat this pathology. The proximal tibiofibular joint ligaments both strengthen the joint and allow it to rotate and translate during ankle and knee motion. Imaging Techniques A spectrum of sports-related injuries resulting in anterolateral dislocation occur due to a violent twisting of the flexed knee with an inverted foot. Dirim B, Wangwinyuvirat M, Frank A, Cink V, Pretterklieber ML, Pastore D, Resnick D. Communication between the proximal tibiofibular joint and knee via the subpopliteal recess: MR arthrography with histologic correlation and stratigraphic dissection. HHS Vulnerability Disclosure, Help More commonly, however, AP and lateral radiographs are performed (Figure 4). 2014 Sep;472(9):2691-7. doi: 10.1007/s11999-014-3574-1. The proximal tibiofibular joint ligaments both strengthen the joint and allow it to rotate and translate during ankle and knee motion. Injuries to the joint are more commonly atraumatic and should be treated with surgery only after all other therapies have been exhausted. In cases where the symptoms of proximal tibiofibular joint instability are difficult to discern, especially for chronic cases, we have found that taping of the proximal tibiofibular joint is helpful to confirm the diagnosis. Would you like email updates of new search results? Atraumatic proximal tibiofibular joint subluxation is the more common presentation of proximal tibiofibular joint instability. The integrity of the proximal tibiofibular joint is best visualized through plain radiographs. Fibular resection during an arthrodesis procedure can decrease ankle pain and instability after surgery. In cases of persistent instability, surgical treatment is indicated. Bookshelf Methods such as arthrodesis and fibular head resection have largely been replaced with various . Bone marrow contusions along both sides of the joint may or may not be present, and fractures are less common (Figures 9 and 10). 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. ABSTRACT 4010 W. 65th St. Knee Surg Sports Traumatol Arthrosc. The integrity of the proximal tibiofibular joint is best visualized through plain radiographs. Management of Proximal Tibiofibular Instability Because the joint is relatively inherently stable because of its bony anatomy when the knee is out straight, most cases of proximal tibiofibular joint instability occur when the knee is bent. Epub 2017 Mar 20. Injection of steroid and anesthetic into the joint can relieve pain and confirm a positive diagnosis. A proximal tib-fib dislocation is a disruption of the proximal tibia-fibula joint associated with high energy open fractures of the tibia and peroneal nerve injury. History and physical examination are very important for diagnosis. A systematic review was performed according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. On MRI, the tibiofibular ligaments are obliquely oriented and extend cephalad from the fibula to the tibia and therefore multiplanar evaluation is essential.10 The anterior ligament is more readily identified given that it is thicker than the posterior ligament. Reconstructive procedures are recommended for patients whose source of pain is instability in the joint as opposed to arthritis. The Proximal Tibiofibular Joint: A Biomechanical Analysis of the Anterior and Posterior Ligamentous Complexes. Axial (5A), coronal (5B) and sagittal (5C) fat-suppressed proton density-weighted images demonstrate the anterior (green arrows) and posterior (blue arrows) PTFJ ligaments. Optimal radiographic evaluation of the PTFJ is performed in 45-60 degrees internal rotation. Is stability of the proximal tibiofibular joint important in the multiligament-injured knee? Instability of the joint can be a result of an injury to these ligaments. Arthritic conditions of the PTFJ are treated similar to those of any diarthrodial joint, with additional option of surgical arthrodesis or resection arthroplasty. Are you experiencing proximal tibiofibular joint instability? Shapiro G.S., Fanton G.S., Dillingham M.F. MeSH 2016 May-Jun;40(3):470-6. doi: 10.1016/j.clinimag.2015.12.011. Instability of this joint may be in the anterolateral, posteromedial, or superior directions. Thank you for choosing Dr. LaPrade as your healthcare provider. All other clinical possibilities should be ruled out before a diagnosis is made. Ogden JA. Sequential axial (1A), coronal (1B), and sagittal (1C) fat-suppressed proton density-weighted images are provided through the proximal tibiofibular joint.
