Symptomatic spur formation of bilateral proximal tibiofibular joints

Irregular types of proximal tibiofibular joint increase the risk of total knee replacement: Data from the osteoarthritis initiative

The study aimed to determine the associations between the morphological types of proximal tibiofibular joint (PTFJ) and the risk of total knee replacement (TKR) in a cohort of participants with progressive osteoarthritis. A nested case-control design was performed in Osteoarthritis Initiative study. The case knees were those with TKR at 24-60 months follow up (cases), and were 1:1 matched with control knees by age, sex, and Kellgren-Lawrence grade at baseline. The morphological type of each PTFJ was identified according to the coronal and sagittal MR images. Conditional logistic regression models were used to examine the association of the PTFJ types with the risk of TKR at baseline and the time point before TKR (T₀ ). A total of 193 case knees at baseline and 148 case knees at T₀ time point had matched controls between 12 and 60 M. Seven types of the PTFJ were identified and classified into three categories: plane, trochoid, and irregular types. The prevalence of the irregular type was higher in case knees than in controls both at baseline (cases vs. controls, 35.8% vs. 26.9%) and at T₀ time point (cases vs. controls, 33.1% vs. 27.0%). The irregular type of the PTFJ at baseline (odds ratio: 1.62, 95% confidence interval: 1.01-2.59) rather than at T₀ time point was significantly associated with increased odds of TKR. The irregular types of the PTFJ at baseline are associated with increased risk of TKR, suggesting PTFJ may play a role in knee osteoarthritis.

Proximal Tibiofibular Joint Arthritis Co-existing With a Medial Meniscal Tear: A Case Report

Proximal tibiofibular joint (PTFJ) arthritis is rare and, thus, not regularly considered as a source of knee pain. In this report, we present the case of a patient with posterior knee pain attributed to a medial meniscal tear rather than to a co-existing PTFJ arthritis, which was not appreciated. Based on the initial diagnosis, the patient underwent knee arthroscopy that did not alleviate his symptoms. The presence of established tibiofibular joint arthritis was diagnosed on subsequent clinical and MRI reassessment. An intra-articular corticosteroid injection settled the patient’s symptoms. The aim of this report is to raise awareness about tibiofibular joint arthritis as a possible cause of posterior or lateral knee pain.

Proximal tibiofibular synostosis as a possible cause of a pseudoradicular syndrome: a case report

This paper presents a case report of persistent low back pain and suspected lumbar radiculopathy. A synostosis at the level of the proximal tibiofibular joint was diagnosed. After successful resection of the synostosis, the low back symptoms resolved completely. This is the first report of a proximal tibiofibular synostosis as a possible cause of referred pain proximally.

Sonographically guided proximal tibiofibular joint injection: technique and accuracy

OBJECTIVE

The purpose of this investigation was to describe a technique for sonographically guided proximal tibiofibular joint (PTFJ) injections and compare its accuracy with that of palpation guided injections in a cadaveric model.

METHODS

A single experienced operator completed 12 sonographically guided and 12 palpation guided PTFJ injections in unembalmed cadavers. The injection order was randomized, and all injections were completed with diluted colored latex. Coinvestigators blinded to the injection technique dissected each specimen and graded the colored latex location as accurate (in the PTFJ), accurate with overflow (within the PTFJ but also in other regions), or inaccurate (no latex in the joint). For statistical analysis, all injections placing latex within the PTFJ were considered "accurate," whereas "inaccurate" injections resulted in no PTFJ latex.

RESULTS

All 12 sonographically guided PTFJ injections accurately placed latex into the PTFJ (100% accuracy), whereas only 7 of 12 palpation guided injections (58%) placed latex within the PTFJ (P = .01). All 5 inaccurate palpation guided injections were superficial and inferior to the PTFJ. Four of 12 accurate sonographically guided PTFJ injections (33%) showed some overflow into the adjacent anterior musculature, whereas 5 of the accurate palpation guided injections (42%) resulted in overflow into the anterior musculature (1), knee joint (2), or both (2).

CONCLUSIONS

This cadaveric investigation suggests that sonographic guidance can be used to inject the PTFJ with a high degree of accuracy and should be considered superior to palpation guidance. Clinicians should consider using sonographic guidance to inject the PTFJ for diagnostic or therapeutic purposes when clinically indicated.

Clinical evaluation of the proximal tibiofibular joint in knees with severe tibiofemoral primary osteoarthritis

Despite the coexistence of primary arthritic involvement of the tibiofemoral and proximal tibiofibular joints (PTFJ), clinical features of the PTFJ in knees with severe femorotibial arthritis have not been described to date. The PTFJ in knees with primary osteoarthritis may be a source of lateral knee pain after total knee arthroplasty operations. This study seeks to address whether there is a relationship between the clinical findings and degeneration of the PTFJ in knees with severe tibiofemoral primary osteoarthritis. Sixty knees in 34 consecutive patients (31 females and 3 males; mean age 71 years; range 61-86 years) with Kellgren-Lawrence grades III-IV primary femorotibial arthritis were enrolled in this study in order to collect clinical data regarding the PTFJ. Radiographs showed 23 PTFJs were grade IV, 14 were grade III, and 23 were grade II. With regard to the type of PTFJ, 13 joints were horizontal and 47 were oblique. Pain and tenderness were observed in 13 PTFJs upon clinical exam (two horizontal and 11 oblique PTFJ types; grade II in five, grade III in two, and grade IV in six). Lateral hamstring tightness was found in 28 knees (24 oblique and four horizontal PTFJ types; grade II in 10, grade III in two, and grade IV in 16). Ten of the 28 PTFJs in knees with lateral hamstring tightness were painful during the physical examination. No significant relationship was found between PTFJ exam findings and PTFJ type (Fisher's Exact test, p=0.713), PTFJ grade of arthritis (chi(2) test, p=0.700), or between hamstring tightness and PTFJ type (chi(2) test, p=0.194). However, hamstring tightness was significantly correlated with the grade of arthritis in the PTFJ (chi(2) test, p=0.004). Although degenerative disease of the PTFJ is commonly associated with degenerative disease of the knee joint, radiographic findings of the PTFJ in patients with severe degenerative knee osteoarthritis and varus malalignment do not correlate with clinical findings.

Radiological evaluation of the proximal tibiofibular joint in knees with severe primary osteoarthritis

The proximal tibiofibular joint (PTFJ) can be considered to be the fourth compartment of knee joint. Although degenerative diseases of the knee joint may also have detrimental effects on the PTFJ until now, details of arthritic affection of PTFJ in the elderly who have severe femorotibial arthritis have not been described. Convenience samples of knees of elderly patients with Kellgren-Lawrence grade III-IV primary osteoarthritis were investigated further in order to determine the X-ray findings of PTFJ. Sixty knees in 34 patients with an average age of 71 years (61-86 years) were examined. Both knees were examined in 26 patients. On the radiographs, 23 joints were grade IV, 14 were grade III, and 23 were grade II. At most, only minor differences were seen between knees on the same patient in terms of lower extremity alignment, grade of TFJ degeneration, grade of PTFJ degeneration, and type of PTFJ. Interobserver correlation was good for radiographic evaluation of PTFJ (kappa = 0.557). By intraobserver analysis with McNemar test, there was no statistically significant difference between the radiographic evaluations of PTFJ (p = 0.167). Arthritic grades of PTFJ and tibiofemoral joints were strongly correlated (Pearson coefficient r = 0.58, p < 0.001). No significant relation was found between type of PTFJ and grade of arthritis (chi(2) test, p = 0.42). In the light of these findings, the proximal tibiofibular joint should be evaluated for arthritic findings that may be responsible for lateral knee pain before a total knee arthroplasty operation is considered. The type of PTFJ is not related to the degree of this joint arthritis.

Involvement of the proximal tibiofibular joint in osteoarthritis of the knee

This study was performed to evaluate the possible involvement of the proximal tibiofibular joint in primary osteoarthritis of the knee. A total of 40 patients with primary osteoarthritis of the knee who had magnetic resonance imaging scans were reexamined for proximal tibiofibular joint involvement. The patient was questioned if pain was present in the proximal tibiofibular joint while at rest, when walking and climbing stairs. Symptoms were evaluated by applying moderate compression over the proximal tibiofibular joint during active ankle and knee motions. Magnetic resonance imaging scans were reexamined by two radiologists. Three of the 40 patients had minimal or moderate pain in the proximal tibiofibular joint during stair-climbing and on clinical examination. Magnetic resonance imaging scans of these three patients revealed osteophyte or subchondral cyst formation, or both. Degenerative changes in the proximal tibiofibular joint may be evident in association with osteoarthritis of the knee and may result in lateral-sided pain at the knee.