Dislocation of the proximal tibiofibular joint

We introduce a new method for fixation of a rare, isolated, proximal tibiofibular dislocation. One third of the biceps femoris muscle tendon was used for fixation of the dislocated proximal fibular head. The fixation was achieved by using a soft threaded interference ACL screw. Received: 6 November 1997     

The abnormal proximal tibiofibular joint

Abnormalities of the proximal tibiofibular joint are infrequently encountered. Mostly instability occurs as a result of trauma. Four types of instability are distinguished: subluxation, anterolateral, posteromedial and superior dislocation. Four radiological methods designed to visualize abnormalities of the proximal tibiofibular joint are discussed. Special notice is given to the clinical relevance of a new method. Instability was demonstrated in 19 patients; 16 of these were treated by an operation. History, data obtained by physical examination and ways of treatment are discussed.     

Traumatic instability of the proximal tibiofibular joint

Proximal tibiofibular instability, seems to be an infrequently diagnosed abnormality, which occurs in isolation or in combination with fractures of the leg and ankle. Four types of instability are distinguished: subluxation, anterolateral dislocation, posteromedial dislocation and superior dislocation.The method of treatment depends on the type of dislocation and on the presence or absence of dysfunction of the peroneal nerve.The methods of treatment are described. Ten patients treated for this instability are presented. The use of radiographs to define the lesion is discussed. Radiographs, taken at follow-up, showed degenerative changes in the proximal tibiofibular joint in 8 of the 10 patients.     

Isolated dislocation of the proximal tibiofibular joint

We have reported the case of an anterolateral dislocation of the proximal tibiofibular joint in a soccer player, apparently the second case in the literature. As in that reported by O'Rourke and McManus, this patient was attempting to gain his balance and this may indeed be an important contributing factor. Ogden's classification is now well accepted and has been reviewed along with a discussion of the mechanisms of injury. The diagnosis can generally be made by clinical examination and confirmed by roentgenographs. Treatment usually consists of closed reduction with 3 weeks of casting. In complicated cases, however, resection of the fibular head may be required.     

Permanent anterior dislocation of the proximal tibiofibular joint

We report two patients with permanent dislocation of the proximal tibiofibular joint and no history of trauma. Both needed operation, one for persistent pain and the other for common peroneal nerve involvement, and both had a good result.     

The proximal tibiofibular joint: an anatomic study

In the first stage of the current study, 14 fresh specimens from above-the-knee amputations were examined by magnetic resonance imaging arthrography. In the second part of the study, these amputation specimens and 38 embalmed knees from cadavers were dissected. The types of the joint and insertion of the biceps femoris tendon and the other structures were observed. Of 14 fresh specimens from above-the-knee amputations examined by magnetic resonance imaging arthrography, nine had a clear communication between the proximal tibiofibular joint and the knee. It was difficult to distinguish the anterior tibiofibular ligament in 30 specimens as a separate band because it was fused intimately with the biceps femoris tendon. Of these specimens, 24 had an oblique type of joint. Because of this communication, the proximal tibiofibular joint might be construed as the fourth compartment of the knee to explain subtle knee problems.     

Bilateral, atraumatic, proximal tibiofibular joint instability

Dislocation of the tibiofibular joint is rare and usually results from a traumatic event. Only 1 case of atraumatic proximal tibiofibular joint instability in a 14-year-old girl has been reported in the literature, however this condition might occur more frequently than once thought. A wide range of treatment options exist for tibiofibular dislocations. Currently, the first choice is a conservative approach, and when this fails, surgical means such as resection of the fibula head, arthrodesis, and reconstruction are considered. However, no consensus exists on the most effective treatment. This article reports a unique case of bilateral, atraumatic, proximal tibia and fibular joint instability involving a 30-year-old man with a 20-year history of pain and laxity in the right knee. The patient had no trauma to his knees; he reported 2 immediate family members with similar complaints, which suggests that this case is likely congenital. After conservative approaches proved to be ineffective, the patient underwent capsular reconstruction using free autologous gracilis tendon. At 6-month postoperative follow-up, the patient was pain free with no locking and instability. He then underwent surgery on the left knee. At 1-year follow-up after the second surgery, the patient had no symptoms or restrictions in mobility. We provide an alternative surgical approach to arthrodesis and resection for the treatment of chronic proximal tibiofibular instability. In the treatment of chronic tibiofibular instability, we believe that reconstruction of the tibiofibular joint is a safe and effective choice.     

Synovial chondromatosis and instability of the proximal tibiofibular joint.

A patient with synovial chondromatosis involving both posterior compartments of the right knee and proximal tibiofibular joint had continued pain and weakness after partial synovectomy. The "Helfet Test" for proximal tibiofibular joint instability was positive; the fibular head was prominent and tender. Following excision of the proximal fibula, the patient was symptom free. This case demonstrates that it is essential to evaluate all joints involved with a disease process prior to surgical intervention.     

Unexplained proximal tibiofibular joint pain after high tibial osteotomy

Problems of the proximal tibiofibular joint (pTFj) after high tibial osteotomy (HTO) are rare. With this case report, we strive to highlight the importance of investigating the pTFj in patients with unexplained knee pain after HTO. A 44 year old male patient presented with diffuse pain on his left knee 3 years after medial opening wedge HTO due to medial compartment overloading in a varus knee. Patient described persistent anterior tibial and lateral knee pain. 2 years after HTO, patient underwent implant removal but the knee pain persisted. As the reason for the persistent pain was not identified, further radiological evaluation was done. Single photon emission computerized tomography/computerized tomography (SPECT/CT) revealed that there was no increased uptake within the tibiofemoral joint, indicating a biologically well performed correction of the varus deformity. However, markedly increased tracer uptake was found at the pTFj. On the inherent axial CT scans, it was seen that the proximal screws were too long and placed within the pTFj. Along with this a severe osteoarthritis of the pTFj was identified. The cause of the patient''s pain was then confirmed by a CT guided infiltration of local anesthetic. An arthrodesis of the pTFj was performed and at 12 months followup after the arthrodesis the patient was pain free. This case highlights how important it is to evaluate the pTFj in patients with unexplained pain after HTO. SPECT/CT was helpful in identifying the patient''s problem in this challenging case.     

Synovial cysts of the proximal tibiofibular joint: three case reports

Synovial cysts are fluid-filled masses lined with synovium and located within or about joints. The main symptoms are pain and/or neurological deficits. They can be intraneural or extraneural or develop between or within muscles. Synovial cysts that arise at a distance from a joint raise diagnostic challenges. We report three cases of synovial cysts of the proximal tibiofibular joint, including an intramuscular cyst responsible for paralysis of the anterolateral leg muscles. Tibiofibular synovial cysts are less common than popliteal cysts, and their pathophysiology is poorly understood. Pressure on the common peroneal nerve is the main complication and requires careful surgical excision of the cyst. Injection of a glucocorticoid into the cyst can be used as the first-line treatment in patients without common peroneal nerve symptoms.     

上胫腓关节脱位的诊断和治疗进展

上胫腓关节脱位在临床相对少见,可以是单纯的脱位,也合并胫骨骨折、腓骨骨折、踝关节等损伤,慢性不稳的患者易被误诊为半月板损伤。由于其临床症状较轻,影像学改变细微,容易被误诊或漏诊,及时的诊断和治疗对于预防膝关节慢性疼痛和不稳至关重要。本文总结了上胫腓关节脱位的解剖基础、损伤分型、诊断要点、手法复位、手术治疗、临床效果及不足等各方面进展,以指导临床工作中对上胫腓关节脱位的诊断和治疗。     

Acute traumatic proximal tibiofibular joint dislocation confirmed by computed tomography

High-quality AP and lateral radiographs of both knees are essential to confirm the diagnosis. Computed tomography may help resolve diagnostic uncertainty and enable earlier closed reduction to be performed. Moreover, CT scans may be more consistently reproducible than the varied quality of emergency radiographs. In this case, the relative severity of the patient's pain and suggestive radiographs led us to obtain CT scans, which confirmed the diagnosis and enabled early successful closed reduction.     

Generalized ligament laxity associated with isolated proximal tibiofibular joint dislocation

Proximal tibiofibular dislocations are a rare orthopaedic injury. It is one that is easily missed if one does not have high clinical suspicion for such an injury. This report discusses two cases of proximal tibiofibular dislocations that presented to the emergency department. In both cases, the patients fulfilled the criteria for having generalized ligamentous laxity—including passive apposition of thumb to extensor aspect of forearm, passive hyperextension of the fingers so that they lie parallel to the forearm, hyperextension of the elbow and knee, and excessive range of passive dorsiflexion of the ankle and eversion of the foot. Both cases also highlighted the difficulty in diagnosing the injury with single X-ray films, requiring additional comparison films to confirm the diagnosis.     

Split biceps femoris tendon reconstruction for proximal tibiofibular joint instability

Recurrent instability of the proximal tibiofibular joint is an infrequently diagnosed abnormality. We present a new technique for reconstructing the joint using a split biceps femoris tendon passed through a bone tunnel in both the proximal tibial metaphysis and fibular head. The case report is also presented. The procedure offers an anatomic reconstruction and firm stabilization. It allows normal motion of the proximal tibiofibular joint and preserves the normal mechanics of the ankle. This procedure is an excellent alternative to resection of the fibular head, transarticular arthrodesis, or pseudoarthrosis focus at the fibular head.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 6 (July-August), 2001: pp 668–671