Tibiofibular Joint

The bones around the knee are the patella (the largest sesamoid bone in the body), the femur, the tibia and the fibula which articulate with each other to form the patellofemoral, tibiofemoral and proximal tibiofibular joints. 

The dislocation is described according to the direction of tibial displacement relative to the femur. Anterior dislocation is the commonest type, and is associated with disruption of the anterior cruciate ligament, the posterior joint capsule and popliteal artery damage. Posterior dislocation can also be associated with arterial injury. Rotary or posterolateral dislocation is caused by force abduction and internal rotation. On the lateral radiograph, the femoral condyle is in profile but the tibia is rotated posterolaterally and the proximal tibiofibular joint is seen in its entirety. An early complete assessment and documentation of the neurovascular status of the leg distally is vital. Also look for signs of compartment syndrome. 

The superior tibiofibular joint is a plane oval articulation. The tibial facet lies on the posterolateral aspect of the rim of the lateral tibial condyle. It faces obliquely posteriorly, inferiorly, and laterally. The inferior tibiofibular joint is a syndesmosis. The tibial facet is a rough concave notch into which the convex fibular facet fits. The fibula has a distal articulation with the tibia and the talus at the ankle. 

Dorsiflexion and plantar flexion of the ankle automatically create motion in both tibiofibular joints. Dorsiflexion causes the lateral malleolus to move laterally, to move vertically in a cephalad direction, and to rotate medially. This causes the superior tibiofibular joint to move in an upward posterior direction while rotating medially. The reverse occurs in plantar flexion. 

The most common somatic dysfunction found in this area is a posterior fibula at the superior tibiofibular joint. This may be second-... 

The knee consists of three separate synovial joints which can be assessed with variable accuracy with US. These are the femorotibial, patellofemoral and superior tibiofibular joint (Fig. 14.1). In some patients, a fourth articulation can exist between the lateral condyle and the fabella, an accessory bone enclosed in the proximal tendon of the lateral head of the gastrocnemius (Fig. 14.1b). 

The superior tibiofibular joint consists of the articulation between the medial articular facet of the fibular head and the corresponding facet of the tibia. It is a small joint located inferolateral to the femorotibial... 

The lateral aspect of the knee joint is examined by asking the patient to rotate the leg internally. From anterior to posterior, the structures to be evaluated are the distal aspect of the iliotibial band, the external femorotibial joint space with the lateral meniscus, the lateral collateral ligament, the popliteus tendon and the superior tibiofibular joint. 

Just deep to the proximal part of the lateral collateral ligament, the popliteus tendon can be imaged on coronal US planes as an oval structure located in its bony groove (Fig. 14.34). Depending on the incidence of the US beam, substantial anisotropy may be evident in the popliteus tendon (De Maeseneer et al. 2002). The US examination of the lateral aspect of the knee should be completed with an evaluation of the superior tibiofibular joint. Transverse and coronal US scans obtained over the anterior aspect of the fibular head are adequate for this purpose. 

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