Proximal Tibiofibular Joint Injury

The proximal tibiofibular joint (PTFJ) has several functions including the dissipation of torsional stresses from the ankle joint, the dissipation of lateral tibial bending moments, and the transmission of axial loads when bearing weight. Acute PTFJ injuries are uncommon and account for less than 1% of all knee injuries and are underinvestigated lateral-sided knee injuries. The PTFJ injuries are categorized into four types: subluxation, anterolateral dislocation, posteromedial dislocation, and superior dislocation. The anterolateral dislocations are most common (85%), and the mechanism of injury of this type II dislocation is a sudden plantar flexion and inversion of the foot combined with an external rotation of the leg with the knee flexed. The common clinical features include the following: lateral knee pain, not being able to bear weight, tenderness upon palpation of the fibula head, motion of the ankle exacerbating knee pain, and inability to fully extend the knee. The management options for PTFJ injuries can be divided into the following: conservative options (such as closed reduction under general anesthesia, and direct weight-bearing mobilization) and—when conservative therapy has failed—several surgical treatment options (such as screw fixation, arthrodesis, fibular head resection, soft-tissue reconstruction, and tightrope fixation).