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Proximal Tibiofibular Joint Dislocation

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Other Names

  • TibFib Joint Dislocation
  • Tibiofibular Joint Dislocation
  • PTFJ dislocation

Background

History

  • First described by Nelaton in 1874 (need citation)

Epidemiology

  • Rare injury poorly described in the literature
  • Most common in 20s - 40s males[1]
  • Accounts for less than 1% of all knee injuries[2]

Pathophysiology

  • Mechanism
    • Dislocation occurs when the knee is held in flexion, foot is rotated and plantar flexed
    • Isolated dislocations are seen in sports involving aggressive twisting of the knee

Injury Patterns

  • Anterolateral dislocation
    • Most common injury pattern, accounting for 85% of dislocations[3]
    • Occurs after a fall with the knee flexed, the ankle inverted, and foot plantar flexed
  • Subluxation
    • Occurs in preadolescent girls and is usually atraumatic
  • Posteromedial dislocation
    • Represents about 10% of cases.
    • Mechanism is usually direct trauma (e.g. blow from the bumper of a car, banging the knee against a gate post while horse riding
    • Higher risk of transient Common Peroneal Nerve Injury
  • Superior dislocation

Associated Conditions

Pathoanatomy

Risk Factors

  • Cases have been described in the following sports
    • Soccer
    • Parachuting
    • Snow‐boarding[4]
    • Long jump[5]
    • Horse riding
    • Rugby

Differential Diagnosis

Clinical Features

  • History
    • Patient will describe some form of trauma
    • Their pain is typically in the lateral knee
    • The patient may endorse crepitus, locking or popping
  • Physical Exam: Physical Exam Knee
    • Visual deformity may be obvious
    • Pain is reproduced by pressure over the fibular head
    • Knee extension may be limited
    • Pain may be worse with ankle movement
    • Foot Drop may be present if there is a peroneal nerve palsy
  • Special Tests

Evaluation

  • Diagnosis is largely clinically
    • Based on mechanism of injury, exam

Radiographs

  • Standard Radiographs Knee or Standard Radiographs Tibia Fibula
    • Depends on the patients chief complaint, may image both
    • Easily missed on XR
    • Diagnostic accuracy with plain AP and lateral radiographs: 72.5%[6]
    • Consider comparing to contralateral limb
  • Findings
    • Interruption of congruity of the proximal tibiofibular joint

CT

  • Imaging study of choice
    • Diagnostic accuracy: 86%[6]

Classification

Ogden Classification[7]

  • Type I
    • Subluxation or ligamentous laxity without dislocation
    • Consistent with atraumatic hypermobility
  • Type II
    • Anterolateral dislocation involving the anterior and posterior tibiofibular ligaments
    • Most common, represents 85% of cases
  • Type III
    • Posteromedial dislocation resulting from a direct trauma
    • Often disrupts the common fibular nerve
  • Type IV
    • Superior dislocation typically resulting from a high energy ankle injury
    • Occasionally associated with a tibial shaft fracture

Management

Prognosis

  • Limited studies on long term outcomes
  • Aladin et al reported only occasional ache after 108 months[8]

Acute

  • Closed Reduction
    • The knee is flexed (80-110°) and the foot dorsiflexed and externally rotated.
    • Pressure is applied over the fibular head while the injury mechanism is reversed, until a “pop” is heard
  • Immobilization
    • Cast
    • Robert–Jones bandage (??)

Nonoperative

  • Indications

Operative

  • Indications
    • Posteromedial dislocation
    • Superior dislocations
    • Failed closed reduction of anterolateral
  • Technique
    • Open reduction and internal fixation

Rehab and Return to Play

Rehabilitation

  • Needs to be updated
  • No consensus guidelines
    • Early rehab up to 6 weeks of immobilization have been proposed[9]

Return to Play/ Work

  • Needs to be updated
  • No clear guidelines

Complications

See Also

References

  1. ↑ Horst PK, LaPrade RF. Anatomic reconstruction of chronic symptomatic anterolateral proximal tibiofibular joint instability. Knee Surg Sports Traumatol Arthrosc 2010;18:1452-5
  2. ↑ Harvey GP, Woods GW. Anterolateral dislocation of the proximal tibiofibular joint: case report and literature review. Todays OR Nurse 1992;14:23-7.
  3. ↑ Resnick D, Newell JD, Guerra J Jr, et al. Proximal tibiofibular joint: anatomic-pathologic-radiographic correlation. AJR Am J Roentgenol 1978;131:133-8
  4. ↑ Ellis C. A case of isolated proximal tibiofibular joint dislocation while snowboarding. Emerg Med J. 2003 Nov;20(6):563-4.
  5. ↑ Laing AJ, Lenehan B, Ali A, Prasad CV. Isolated dislocation of the proximal tibiofibular joint in a long jumper. Br J Sports Med. 2003 Aug;37(4):366-7
  6. ↑ 6.0 6.1 Keogh P, Masterson E, Murphy B, McCoy CT, Gibney RG, Kelly E. The role of radiography and computed tomography in the diagnosis of acute dislocation of the proximal tibiofibular joint. Br J Radiol. 1993 Feb;66(782):108-11
  7. ↑ Ogden, John A. "Subluxation and dislocation of the proximal tibiofibular joint." JBJS 56.1 (1974): 145-154.
  8. ↑ Aladin A, Lam KS, Szypryt EP. The importance of early diagnosis in the management of proximal tibiofibular dislocation: a 9- and 5-year follow-up of a bilateral case. Knee. 2002 Sep;9(3):233-6.
  9. ↑ Nieuwe Weme RA, Somford MP, Schepers T. Proximal tibiofibular dislocation: a case report and review of literature. Strategies Trauma Limb Reconstr 2014;9:185-9.
Created by:
John Kiel on 7 July 2019 07:18:49
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Last edited:
15 March 2023 16:38:45
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