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Instability of the Proximal Tibiofibular Joint

Dr. Sekiya is Lieutenant Commander, Medical Corps, United States Navy, Bone and Joint/Sports Medicine Institute, Department of Orthopaedic Surgery, Naval Medical Center, Portsmouth, VA. Dr. Kuhn is Associate Professor, Division of Sports Medicine, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI.

Reprint requests: Dr. Kuhn, Box 0363, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106-0363.

Injury to the proximal tibiofibular joint is typically seen in athletes whose sports require violent twisting motions of the flexed knee. Instability of this joint may be in the anterolateral, posteromedial, or superior directions. With acute injury, patients usually complain of pain and a prominence in the lateral aspect of the knee. A closed reduction should be attempted in patients with acute dislocation. If this is unsuccessful, open reduction and stabilization of the joint with repair of the injured capsule and ligaments can be done. Patients with chronic dislocation or subluxation report lateral knee pain and instability with popping and catching, which may be confused with lateral meniscal injury. Symptoms of subluxation may be treated nonsurgically with physical therapies such as activity modification, supportive straps, and knee strengthening. For patients with chronic pain or instability, surgical options include arthrodesis, fibular head resection, and proximal tibiofibular joint capsule reconstruction.

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