Kinematics of the proximal tibiofibular joint is influenced by ligament integrity, knee and ankle mobility: an exploratory cadaver study
The proximal tibiofibular joint (PTFJ) is a rather unknown articulation. There is little understanding of its anatomy, physiology, and functional role. The objectives of this research are to describe the normal kinematics of the PTFJ and its relation to the ankle and knee movements.
Fourteen knees of seven adult fresh frozen whole body cadavers were studied. The proximal tibiofibular joint and ligaments were identified, after which we sequentially sectioned the anterior proximal tibiofibular ligament (APTFL), the posterior proximal tibiofibular ligament (PPTFL), and the interosseous syndesmotic membrane. Models with intact and sectioned ligaments were compared, while the unloaded lower limb was manually mobilized in a pre-defined sequence of combined movements of knee, ankle, and proximal tibiofibular joints. The PTFJ spatial displacement was measured by analyzing the length of a distance vector between two 3D coordinate systems settled over the tibia and fibula.
On the unaltered PTFJ, direct grasping of the head of the fibula with the hip in 45° of flexion and the knee in 90° of flexion was found to produce an average displacement of 7 mm. Knee movements caused the greatest spatial displacements, almost ten times the ones produced by ankle flexion/extension. Flexion/extension of the knee caused 1.8 times more displacement than single rotations with the knee flexed to 90°. It was found that the APTFL was an important stabilizer of the PTFJ when this joint is tensioned accommodating the movements of ankle extension and foot eversion. The APTFL was not a significant stabilizer of the PTFJ during direct manipulation of the fibular head when imprinting a manual force with posterior direction. The PPTFL was an important accommodator of ankle flexion, foot inversion and knee flexion. The interosseous syndesmotic membrane also proved to be a significant PTFJ stabilizer in rotational movements of the ankle and knee.
This is the first cadaver study to illustrate the PTFJ normal spatial displacement, thereby contributing to a deeper insight of this joint. The contribution of each ligament for PTFJ stability was described and, based on these findings; a new mechanism of injury was suggested. Surgeons can translate the results of this study into the clinical practice.
KeywordsProximal tibiofibular joint Tibiofibular instability 3D kinematics Knee
Proximal tibiofibular joint
- Distal TFJ
Distal tibiofibular joint
Anterior proximal tibiofibular ligament
Posterior proximal tibiofibular ligament
Interosseous syndesmotic membrane
Range of motion
We thank Professor João Goyri O’Neil and the Department of Anatomy of Medical College, Universidade Nova de Lisboa for provision of the specimens and assistance with laboratory setup. We thank Escola Superior de Saúde, Instituto Politécnico de Setúbal for providing the hardware and software for the 3D kinematic analysis. We thank Physiotherapist Mario Valerio and PhD Candidate Rodrigo Brandão Martins for providing support during data collection and analysis.
TAS, PP, and FGP conceived the study, participated in its design and coordination, carried out the experimental study, participated in the sequence alignment, and drafted the manuscript. RM participated in the study design and data analysis. All authors read and approved the final manuscript.
No funding has been received for this study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests with respect to the research, authorship and publication of this article. The authors received no financial support for the research, authorship and publication of this article.
This article does not contain any studies with living human participants performed by any of the authors.
For this type of study formal consent is not required.
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