Anatomical basis of the support of fibula to tibial plateau and its clinical significance

Abstract

Background The fibula is only indirectly involved in the composition of the human knee joint and has therefore been neglected in the research on knee osteoarthritis. Nonuniform settlement of the proximal tibia plateau is clinically defined as when the height of the medial tibial plateau is lower than that of the lateral side in medial compartment knee osteoarthritis (KOA). The non-uniform settlement of the proximal tibia plateau may be caused by fibular support on the lateral side. Orthopedic surgeons practice partial fibulectomy based on the clinical manifestation of nonuniform settlement, and this technique has been shown to reduce pain and improve function in patients with medial compartment KOA. However, this hypothesis of the mechanism of nonuniform settlement lacks an anatomical basis. Methods The P45 polyester plastination technique was used to prepare sections of the proximal tibiofibular joint to investigate the distribution of the bone trabeculae in the region of the lateral tibial plateau. Results There was uneven distribution of trabeculae in the lateral condyle of the tibia and the head and neck of the fibula. The fibula and the posterolateral cortex of the shaft of the tibia united to form an arch beam via the tibiofibular joint. Many thick, dense trabeculae were present in a longitudinal direction above the tibiofibular arch. Conclusions The fibula supports the lateral tibial plateau, and the trabeculae were concentrated above the tibiofibular arch.

Proximal tibiofibular joint (PTFJ) dislocation due to Ehlers-Danlos syndrome: posterolateral open-wedge high tibial osteotomy combined with medial closed-wedge distal femoral osteotomy can correct the severe valgus deformity with a markedly increased tibial posterior slope

“…Traumatic PTFJ dislocation in adulthood, although rare,13 provides little useful information about the effects of PTFJ dislocation in skeletally immature knees on bony growth and/or bony deformities. From the present case, we found that the dislocation of the fibula, which acts as a supporting strut for the posterolateral part of the tibial condyle,14 15 caused dysplasia of the posterolateral tibia, resulting in valgus knee alignment. It is possible that excessive lateral compartment loading exerted a compression force on the distal lateral femur, which also induced a valgus deformity of the distal femur.…”

Classification of Bone Bruises in Pediatric Patients With Anterior Cruciate Ligament Injuries

“…The tibiofibular arch plays an important role in bearing downward forces of the lateral compartment of the knee joint. 5 , 16 Therefore, we speculate that bone bruises of the fibular head occurred because of a large degree of traumatic energy that could not be limited to the lateral tibial plateau. Our hypothesis was supported by our finding that no patient had a grade I bone bruise classified as type d, which shows that the energy was too small to reach the fibular head in patients with grade I bone bruises.…”

Radiological Study on Fibular Morphology in Knee Osteoarthritis

“…One study concluded that the bula can bear one-sixth of an individual's body weight [14] . Jiang et al [15] reported an even distribution of bone trabeculae between the lateral condyle of the tibial plateau and the neck of the bula head. The posterolateral cortex of the bula and tibia is combined through the PTFJ to form an arch beam, with several thick and dense bone trabeculae present in the longitudinal direction above the PTFJ.…”

“…The study evaluated the radiological severity of KOA on the basis of the K-L grading system. According to the results of X-ray examinations, KOA was rated grade I to IV [15]. Grade I indicates suspected narrowing of the joint space, possibly with osteophytes.…”