Abstract
Purpose
Limited objective data exist detailing the quantitative anatomy of the individual bundles of the proximal tibiofibular joint and their relation to surgically pertinent osseous landmarks. The purpose of this study was to qualitatively and quantitatively describe the ligamentous anatomy of the proximal tibiofibular joint and its relation to relevant bony landmarks.
Methods
Ten non-paired, fresh-frozen cadaveric knee specimens were dissected to identify the proximal tibiofibular joint ligament bundles. Pertinent bony landmarks were identified and served as reference points for the tibial and fibular attachments for each bundle. Ligament bundle footprints, lengths and orientations were measured using a 3D coordinate measuring device.
Results
Up to four bundles were identified anteriorly and up to three bundles posteriorly. The inferior bundle was identified anteriorly and posteriorly in 60% and 20% of the cases, respectively. For the anterior complex, the centres of the tibial attachments were a mean distance of 12.5 mm (95% CI [10.7, 14.3]) and 25.3 mm (95% CI [21.6, 29.0]) from the tibial plateau for the superior and inferior bundles, respectively. The centres of the fibular attachments were 11.3 mm (95% CI [7.4, 15.1]) and 27.0 mm (95% CI [24.0, 30.0]) from the apex of the fibular styloid for the superior and inferior bundles, respectively. For the bundles of the posterior complex, the centres of the tibial attachments were 13.4 mm (95% CI [11.6, 15.2]) and 38.8 mm (95% CI [31.0, 46.6]) distal to the tibial plateau for the superior and inferior bundles, respectively, and the centres of the fibular attachments were 8.0 mm (95% CI [5.8, 10.1]) and 29.3 mm (95% CI [25.5, 33.1]) from the apex of the fibular styloid for the superior and inferior bundles, respectively. In the coronal plane, the mean 2D angle between the medial to lateral knee joint axis and the axis passing through the centre of the proximal tibiofibular joint and the centre of the tibial plateau was 16.9° (95% CI [12.8, 21.0]).
Conclusion
The ligament bundles of the proximal tibiofibular joint were reproducibly identified between specimens in relation to surrounding bony landmarks. Up to four bundles were identified in the anterior ligament complex and up to three in the posterior complex. Variation in bundle orientation and footprint size was observed. Based on these findings, an anatomic reconstruction can be performed using surrounding reliable landmarks.
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References
Bozkurt M, Yilmaz E, Atlihan D, Tekdemir I, Havitcioglu H, Gunal I (2003) The proximal tibiofibular joint: an anatomic study. Clin Orthop Relat Res 406:136–140
Draganich LF, Nicholas RW, Shuster JK, Sathy MR, Chang AF, Simon MA (1991) The effects of resection of the proximal part of the fibula on stability of the knee and on gait. J Bone Joint Surg Am 73(4):575–583
Espregueira-Mendes JD, da Silva MV (2006) Anatomy of the proximal tibiofibular joint. Knee Surg Sports Traumatol Arthrosc 14(3):241–249
Geeslin AG, LaPrade RF (2011) Outcomes of treatment of acute grade-III isolated and combined posterolateral knee injuries: a prospective case series and surgical technique. J Bone Joint Surg Am 93(18):1672–1683
Grood ES, Suntay WJ (1983) A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 105(2):136–144
Halbrecht JL, Jackson DW (1991) Recurrent dislocation of the proximal tibiofibular joint. Orthop Rev 20(11):957–960
Horan J, Quin G (2006) Proximal tibiofibular dislocation. Emerg Med J 23(5):e33
Horst PK, LaPrade RF (2010) Anatomic reconstruction of chronic symptomatic anterolateral proximal tibiofibular joint instability. Knee Surg Sports Traumatol Arthrosc 18(11):1452–1455
Jabara M, Bradley J, Merrick M (2014) Is stability of the proximal tibiofibular joint important in the multiligament-injured knee? Clin Orthop Relat Res 472(9):2691–2697
Marchetti DC, Moatshe G, Phelps B, Dahl K, Ferrari MB, Chahla J et al (2017) The proximal tibiofibular joint: a biomechanical analysis of the anterior and posterior ligamentous complexes. Am J Sports Med. doi:10.1177/0363546517697288
Noyes FR, Butler DL, Grood ES, Zernicke RF, Hefzy MS (1984) Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg Am 66(3):344–352
Ogden JA. (1974) The anatomy and function of the proximal tibiofibular joint. Clin Orthop Relat Res 101:186–191
Ogden JA (1974) Subluxation and dislocation of the proximal tibiofibular joint. J Bone Joint Surg Am 56(1):145–154
Ogden JA. (1974) Subluxation of the proximal tibiofibular joint. Clin Orthop Relat Res 101:192–197
Parkes JC 2nd, Zelko RR (1973) Isolated acute dislocation of the proximal tibiofibular joint. Case report. J Bone Joint Surg Am 55(1):177–183
See A, Bear RR, Owens BD (2013) Anatomic mapping for surgical reconstruction of the proximal tibiofibular ligaments. Orthopedics 36(1):e58–e63
Sekiya JK, Kuhn JE (2003) Instability of the proximal tibiofibular joint. J Am Acad Orthop Surg 11(2):120–128
Serra Cruz R, Mitchell JJ, Dean CS, Chahla J, Moatshe G, LaPrade RF (2016) Anatomic posterolateral corner reconstruction. Arthrosc Technol 5(3):e563–572.
Sugita T, Amis AA (2001) Anatomic and biomechanical study of the lateral collateral and popliteofibular ligaments. Am J Sports Med 29(4):466–472
Warner BT, Moulton SG, Cram TR, LaPrade RF (2016) Anatomic reconstruction of the proximal tibiofibular joint. Arthrosc Technol 5(1):e207–210.
Williams BT, James EW, LaPrade RF (2016) A physeal-sparing fibular collateral ligament and proximal tibiofibular joint reconstruction in a skeletally immature athlete. Knee Surg Sports Traumatol Arthrosc 24(3):661–665
Wu G, Cavanagh PR (1995) ISB recommendations for standardization in the reporting of kinematic data. J Biomech 28(10):1257–1261
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Dr. LaPrade is a paid consultant and recieves IP royalties and research support from Arthrex, Inc., Össur, and Smith & Nephew. Dr. Moatshe has received research grants from Arthrex Inc. and South Eastern Norway Health Authorities (Helse Sør-Øst), Norway.
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This study was internally funded by the Steadman Philippon Research Institute.
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The article does not contain any studies with human participants or patient data.
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Informed consent was obtained from all individual participants included in the study.
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Anavian, J., Marchetti, D.C., Moatshe, G. et al. The forgotten joint: quantifying the anatomy of the proximal tibiofibular joint. Knee Surg Sports Traumatol Arthrosc 26, 1096–1103 (2018). https://doi.org/10.1007/s00167-017-4508-8
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DOI: https://doi.org/10.1007/s00167-017-4508-8