Communication Between the Proximal Tibiofibular Joint and Knee via the Subpopliteal Recess: MR Arthrography with Histologic Correlation and Stratigraphic Dissection

Abstract

The frequency of the communication between the proximal TFJ and knee via the subpopliteal recess related to a defect in the posterior ligament of the fibular head was found to be 27.5%. Evidence of an injury was present in 9% of anatomic specimens that had such communication. Injury to the posterior ligament of the fibular head and instability of the proximal TFJ may accompany a variety of knee injuries. Knowledge of the detailed anatomic appearance and MRI characteristics of the structures related to the proximal TFJ is key to identifying injuries to these structures.

Chondrocalcinosis of Femoro-Tibial and Proximal Tibio-Fibular Joints in Cadaveric Specimens: A High-Resolution CT Imaging Study of the Calcification Distribution

“…Articular calcifications may also involve both femoro-tibial and proximal tibio-fibular joints. An anatomical communication between the femoro-tibial joint and the proximal tibio-fibular joint does exist in 10 to 27.5% of cases [18], [19]. It may be one explanation to the involvement of both joints since the proximal tibio-fibular joint has limited mobility and undergoes less mechanical stress than the femoro-tibial joint.…”

Sonographically Guided Proximal Tibiofibular Joint Injection

“…The results of our palpation guided PTFJ injections appropriately reflect the difficulty of placing a needle into this small, anatomically complex joint, despite the ability to easily palpate the fibular head. 1,6,7,33 Without the use of image guidance, the operator must judge needle depth based on experience and "feel." The inaccurate, superficially placed injections likely resulted from the inability to feel the needle drop into the articulation on the initial pass.…”

Sonographically Guided Popliteus Tendon Sheath Injection

“…The primary difference between the longitudinal and transverse approaches is that in the latter case, the needle is placed deep to the popliteus tendon and therefore closer to and potentially within the popliteus hiatus. 1,3,10,12,24,25 This needle placement, in combination with the downward pressure exerted by the popliteus tendon itself, could have contributed to latex flowing into the knee joint via the popliteus hiatus along the path of least resistance. In fact, during multiple transverse approach injections, the senior author visualized low-pressure flow medially and anteriorly toward the popliteus hiatus, despite positioning the limb in slight knee flexion and internal rotation to relax the popliteus.…”