The superior tibiofibular joint: the forgotten joint.

Clinicians and anatomists have ignored the superior tibiofibular joint too long. As Dr. Arthur Helfet5 states: "The superior tibiofibular joint has suffered clinical and literary neglect." Although pathology of this joint is relatively uncommon, it must be considered as a differential diagnosis. Persistent, vague symptoms of the lateral aspect of the knee may include pathology to the superior tibiofibular joint as well as the more common problems (lateral meniscus, lateral capsule, lateral musculature, lateral compartment pathology, etc.). A careful, thorough, systematic evaluation must be performed if appropriate care is to be rendered. The first portion of this paper deals with the anatomy, biomechanics, and mechanisms of injury of the superior tibiofibular joint. The second portion of the Raper includes the evaluation and treatment of injuries to this joint, while the final portion includes illustrative case studies. The fibula is described as a long, slender, bone located in the lateral aspect of the leg. Evans3 found the middle and proximal thirds of the fibula have great ability to withstand tensile forces. The tensile strength of these areas was calculated to be greater than any other osseous component in the skeleton. The distal and proximal portions of the fibula are expanded and articulate with the talus and tibia, respectively. The distal expansion is referred to as the lateral malleolus while the proximal expansion is termed the fibular head. The inferior tibiofibular articulation is of a syndesmonic (nonsynovial) nature, while the superior joint is synovial. The head of the fibula articulates on the posterolateral and inferior aspect of the lateral tibial condyle. A single facet of the fibular head articulates with the tibia. Ogden8 has revealed that there are essentially two types of superior tibio-