Radiographical definition of the proximal tibiofibular joint – A cross-sectional study of 2984 knees and literature review |
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| Institution: | 1. Department of Orthopaedic Surgery National University Health System, Singapore;2. Department of Diagnostic Imaging National University Health System, Singapore;1. AO Research Institute Davos, Davos Platz, Switzerland;2. Medical Faculty, Albert Ludwigs University of Freiburg, Freiburg, Germany;1. Department for Plastic Surgery, Hand Surgery and Reconstructive Microsurgery, BG Trauma Center Murnau am Staffelsee, Germany;2. Department for Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, Germany;1. Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Sun Hospital, Daejeon, Korea;2. Department of Orthopaedic Surgery, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, Korea;1. University of California, Irvine, 101 The City Drive South Building 29A, Pavilion III – 2nd Floor Orange, Irvine, Orange, CA 92868, USA;2. University of Pennsylvania, Philadelphia, PA USA;1. Department of Orthopaedic Surgery, Santobono Pausilipon Children Hospital, Naples, Italy;2. Department of Neurosurgery, University of Milan, Milan, Italy;3. Department of Anesthesiology, University of Milan, Milan, Italy |
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| Abstract: | BackgroundProximal tibiofibular joint (PTFJ) injuries are not uncommon but relatively understudied. This study evaluates the effectiveness of 2 radiographic methods in assessing the integrity of the PTFJ.Study designThis is a cross-sectional study of 2984 consecutive patients with knee X-rays done in a single institution over a 4-month period. A total of 5968 knee X-rays were assessed using 2 methods–1] The direction in which the fibula points to in relation to the lateral femoral epicondyle on anteroposterior view and Blumensaat line on lateral view. 2] The degree of tibiofibular overlap as percentage of widest portion of the fibula head. Sensitivity and specificity of these methods in diagnosing a disrupted PTFJ are calculated. Variables including quality of X-rays, weight-bearing status of AP views and degree of knee flexion on lateral views are also recorded. Univariate analysis was carried out to investigate the association between variables using chi-square test for nominal data and student t-test for continuous data.ResultsThe fibular points towards the lateral femoral epicondyle on AP view in 94.4% of the patients and points towards the posterior half of the Blumensaat line on lateral view in 98.1% of the patients. Using this method, weight-bearing X-rays are significantly associated with the direction the fibula is pointing (p < 0.01) on the AP view and the degree of knee flexion is associated with the direction the fibula is pointing (p < 0.01) on the lateral view.The AP tibiofibular overlap ranges from >0% to <75% in 94.1% of the patients and the lateral tibiofibular overlap ranges from >0% to <75% in 84.5% of the patients.This method is associated with whether true orthogonal X-rays of the knees are taken (p = 0.048).ConclusionThe direction in which the fibula is pointing and the percentage of tibiofibular overlap are highly specific radiographic methods useful in defining the PTFJ. The first method requires a weight-bearing view on AP assessment and >20 degrees of flexion on lateral assessment. True orthogonal AP and lateral views are required for the second method to be used. |
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| Keywords: | Proximal tibiofibular joint Subluxation Dislocation Radiographs Knee |
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