We anticipate that our patients will return back to full activities about 4-5 months after surgery, following the rehabilitation program. In this regard, it is recommended that the strengths of grafts chosen for proximal tibiofibular reconstructions meet or exceed these values. Related . 1974 Jun;(101):192-7. I was told by one of the orthopedic surgeons that I worked with that I would never run again and would be lucky if I could ever hike again. Edina, MN 55435, EAGAN-VIKING LAKES OFFICE I am 5-months post surgery, and am doing great, stationary biking and exercising every day, no pain.You know you are seeing the best when you find out he has written over 500 medical journal articles - among many other accomplishments. Internal bracing is performed with a knotless suture button (TightRope syndesmosis implant; Arthrex). The arthrodesis procedure is recommended for patients in whom the correction of joint instability would not relieve pain, such as patients with proximal tibiofibular joint arthritis. Reconstruction is recommended to maintain correct anatomic function and rotation of the joint. Fibular resection during an arthrodesis procedure can decrease ankle pain and instability after surgery. 2018 Feb 26;7(3):e271-e277. Instability of this joint may be in the anterolateral, posteromedial, or superior directions. Nonoperative treatment is associated with persistent symptoms, whereas both fixation and fibular head resection are associated with high complication rates. Dr LaPrade performed a deep root repair to my meniscus, which saved me from a knee replacement at this time. The first step in the management of chronic instability of the PTFJ is usually . Initial management of traumatic joint dislocation should involve closed reduction under local anesthesia, followed by surgical intervention if reduction fails. In acute cases, we have found that immobilization in a brace in full extension for 3 weeks is often very effective to allow the posterior proximal tibiofibular joint ligament tear to scar in sufficiently such that there is no instability. 2010 Nov;18(11):1452-5. doi: 10.1007/s00167-010-1049-9. Instability of the proximal tibiofibular joint is a very rare condition that is often misdiagnosed when there is no suspicion of the injury. The early recognition of instability in the proximal tibiofibular joint is necessary to optimize management of the injury and to avoid potential misdiagnosis. Right Knee Surgery After Auto Bicycle Accident, Medical Second Opinion Service MRI/X-ray Review. Abstract Dislocation of the tibiofibular joint is rare and usually results from a traumatic event. Proximal tibiofibular joint (PTFJ) instability can be easily missed or confused for other, more common lateral knee pathologies such as meniscal tears, fibular collateral ligament injury, biceps femoris pathology, or iliotibial band syndrome. MRI evaluation of recent injury will often reveal soft tissue edema both anterior and posterior to the joint, as well as within the ligaments. The proximal fibula moves posteromedial with knee extension. Marchetti DC, Chahla J, Moatshe G, Slette EL, LaPrade RF. Recent traumatic anterolateral proximal tibiofibular joint dislocation. Gross anatomy Articulation fibula: flat facet of the fibular head Rev Chir Orthop Reparatrice Appar Mot. The proximal tibiofibular joint ligaments both strengthen the joint and allow it to rotate and translate during ankle and knee motion. LaPrade RF, Hamilton CD. On MRI, the tibiofibular ligaments are obliquely oriented and extend cephalad from the fibula to the tibia and therefore multiplanar evaluation is essential.10 The anterior ligament is more readily identified given that it is thicker than the posterior ligament. Initial management of traumatic joint dislocation should involve closed reduction under local anesthesia, followed by surgical intervention if reduction fails. AJR Am J Roentgenol. Axial fat-suppressed proton density-weighted images demonstrates a poorly defined chronically torn posterior PTFJ ligament (blue arrowhead). Plain radiographs should be taken from anteroposterior, lateral, and oblique (45 to 60 degrees internal rotation of the knee) views, with comparison views from the contralateral knee, or from the preinjury knee if possible. While it is often difficult to identify a complete tear, in the absence of a history of dislocation or instability, edema in the ligaments associated with a fibular bone bruise along the posterior ligament attachment should raise awareness of recent traumatic injury. Most patients are cleared to begin full activities between four to six months postoperatively, assuming they have adequate restoration of proximal tibiofibular joint stability, pain relief, and return of strength, agility and endurance. Patients often report symptoms such as knee instability and giving way during these activities, as well as clicking and popping during daily activities.3 Instability of the proximal tibiofibular joint . A Primer and Practical Guide to the Diagnosis of Joint Pain and Inflammation. Clin Orthop Relat Res. Imaging of Proximal Tibiofibular Joint Instability: A 10 year retrospective case series. Reconstructive procedures are recommended for patients whose source of pain is instability in the joint as opposed to arthritis. The diagnosis is often unknown and delayed due to its variable and . The examination of patients with atraumatic subluxation or chronic instability should be performed with the knee flexed to 90 degrees. Dr. LaPrade and his team have developed an anatomic proximal posterior tibiofibular joint reconstruction procedure. It is common for patients to also have transient peroneal nerve injuries, especially with posteromedial dislocation.1,2 Before Instability of the joint can be a result of an injury to these ligaments. Anterolateral dislocation commonly stems from injury to the anterior and posterior capsular ligaments, and commonly the lateral collateral ligament.1,2 The common cause of traumatic anterolateral dislocation is a fall on a flexed knee, or a violent twisting motion during an athletic activity.3 The hyperflexed knee results in relaxation of the biceps femoris tendon and the lateral collateral ligament, and the violent twisting of the body creates a torque that pushes the fibular head laterally to the edge of the lateral tibial metaphysis.1,2 The forced plantar flexion and ankle inversion forces the laterally displaced fibular head anteriorly.1, The early recognition of instability in the proximal tibiofibular joint is necessary to optimize management of the injury and to avoid potential misdiagnosis. Surgical treatment discussion and videos courtesy of Jonathan A. Godin, MBA, MD, The Steadman Clinic and Steadman Philippon Research Institute. History of Traumatic Injury Epub 2010 Feb 3. Because the posterior ligament is thinner it is often more difficult to identify and best evaluated on axial and sagittal images just anterior to the popliteus musculotendinous unit (Figure 5). 2000 Mar-Apr;28(2):191-9. doi: 10.1177/03635465000280020901. Clinical and Surgical Pearls It is common for patients to also have transient peroneal nerve injuries, especially with posteromedial dislocation.1,2. Axial (7A) and coronal (7B) fat-suppressed proton density-weighted images demonstrate soft tissue edema at the PTFJ and a tear of the posterior ligament (blue arrows) near the fibular attachment. To provide the highest quality clinical and technology services to customers and patients, in the spirit of continuous improvement and innovation. In order to best treat this pathology, Dr. LaPrade and his team have developed an anatomic proximal posterior tibiofibular joint reconstruction procedure. The fracture was extremely difficult to visualize on radiographs. Proximal Tibiofibular Joint Injuries - Discussion: - function of the PTFJ - accept 1/6 the axial load of the leg - resist torsional stresses originating from the ankle - resist tensile forces created with weight bearing - resists lateral bending forces - subluxation is common in preadolescent females and resolves with skeletal maturity In more chronic cases, we have the patient squat down, which can often demonstrate that the proximal tibiofibular joint is being subluxed. Injection of steroid and anesthetic into the joint can relieve pain and confirm a positive diagnosis. The most common traumatic dislocations are in an anterolateral direction, followed by posteromedial and superior dislocations. Treatment for proximal tibiofibular joint stability requires that nonsurgical management be attempted first for patients with atraumatic subluxation of the proximal tibiofibular joint. As the anterior arm of the long head of the biceps femoris tendon courses inferiorly, it contributes to the anterior aponeurosis and is intimately associated with the anterior tibiofibular ligament (green arrows). A chronically injured CPN may appear atrophic with abnormally increased T2 signal as well as an abnormal contour due to surrounding scar tissue which often effaces the normal perineural fat. The vast majority of the time, the torn ligaments are the posterior proximal tibiofibular joint ligaments, so a graft which is placed in the anatomic position to restore these ligaments has been proven to be successful. 2022 Jun 11;14(6):e25849. Optimal radiographic evaluation of the PTFJ is performed in 45-60 degrees internal rotation. Traumatic dislocations of the proximal tibiofibular joint are uncommon and are normally caused by high-energy injury or a fall on a twisted knee. Arthritic conditions of the PTFJ are treated similar to those of any diarthrodial joint, with additional option of surgical arthrodesis or resection arthroplasty. The arthrodesis procedure is recommended for patients in whom the correction of joint instability would not relieve pain, such as patients with proximal tibiofibular joint arthritis. The drill is advanced through all 4 cortices. Clin Orthop Relat Res. Proximal tibiofibular joint instability is a very unusual and uncommon condition. Diagnosis requires careful assessment of radiographs of the knee and tibia (often missed injury). ABSTRACT Atraumatic instability is more common and often misdiagnosed. The drill sleeve is applied to the lateral aspect of the fibular head, avoiding the insertions of the FCL and the BFT. Imaging Techniques Proximal tibiofibular (PTF) joint instability is a rare condition: only 96 cases have been reported in the published literature. Injuries to the joint are more commonly atraumatic and should be treated with surgery only after all other therapies have been exhausted. Patients who undergo this reconstruction are kept on crutches for 6 weeks with no to minimal weight-bearing movement, but are allowed full range of motion. Epub 2022 Apr 1. I can run, bike, & climb mountains. A fibular bone bruise (asterisk) is present near the attachment of the posterior ligament. We recommend joint reconstruction to repair the proximal tibiofibular joint, which will retain the functional anatomy and rotation of the joint, over arthrodesis, especially in children and athletes. Pessoa P, Alves-da-Silva T, Guerra-Pinto F. Knee Surg Sports Traumatol Arthrosc. Chronic instability is commonly the result of untreated or misdiagnosed subluxation of the PTFJ. A sagittal image through the posterior aspect of the PTFJ demonstrates the normal posterior ligament. Methods: PMID: 20440223. Atraumatic subluxation is thought to result from injury to the anterior ligament and to the anterior capsule of the joint, and it can be associated with Ehlers-Danlos syndrome, muscular dystrophy, and generalized laxity. Protection of the peroneal nerve during surgery helps to prevent injury and relieves symptoms common to this injury. Proximal tibiofibular ligament reconstruction, specifically biceps rerouting and anatomic graft reconstruction, leads to improved outcomes with low complication rates. Proximal tibiofibular dislocation is commonly missed initially when high-energy trauma results in other traumatic fractures as well, such as injury to the tibial plateau or shaft, injury to the ipsilateral femoral head or shaft, ankle fracture, or knee dislocation.1,2 April 25, 2013 - Appointment with Dr. Lyman, MD-Lyman Knee Clinic, Coeur D'Alene, ID. History and physical examination are very important for diagnosis. 3. I have looked many times for answers on my tibial tubercle osteotomy and never found any as detailed as i needed. Limit patients to passive flexion until 6 weeks to reduce the stress that is applied to the reconstructed ligaments (prevent biceps femoris from pulling on the fibular head). Moatshe G, Cinque ME, Kruckeberg BM, Chahla J, LaPrade RF. 2016 May-Jun;40(3):470-6. doi: 10.1016/j.clinimag.2015.12.011. Atraumatic proximal tibiofibular joint subluxation is the more common presentation of proximal tibiofibular joint instability. Conclusion: The ligaments of the human proximal tibiofibular joint were able to withstand a mean ultimate failure load of 517 144 N for the anterior complex and 322 160 N for the posterior complex. We have found it to be very effective at restoring stability to this joint and not resulting in joint overconstraint. Particular attention is paid to the status of the menisci, patellofemoral tracking, cruciate ligaments, and presence of loose bodies as pathologies in these areas can mimic . The TightRope needle is then passed through to the anteromedial aspect of the tibia until it exits the skin medially. Displacement of the fibular head in relation to the tibiavisible or palpable deformity. Axial fat-suppressed proton density weighted image at the PTFJ demonstrates marked soft tissue edema surrounding the joint with intact anterior (green arrow) and posterior (blue arrow) PTFJ ligaments. Anatomic Acromioclavicular Joint Reconstruction, Arthroscopic Lateral Retinacular Release and Lateral Retinacular Lengthening, Arthroscopic and Open Management of Scapulothoracic Disorders, Medial Patellofemoral Ligament Reconstruction and Repair for Patellar Instability, Management of Pectoralis Major Muscle Injuries, Combined Anterior Cruciate Ligament Reconstruction and High Tibial Osteotomy, Patient Positioning, Portal Placement, and Normal Arthroscopic Anatomy, Surgical Techniques of the Shoulder Elbow and Knee in Sports. Anterolateral dislocation commonly stems from injury to the anterior and posterior capsular ligaments, and commonly the lateral collateral ligament. Flexing the knee to 90 degrees to relax the lateral collateral ligament and biceps femoris tendon, then moving the fibular head anteriorly and posteriorly, can test instability of the joint. Orthop Rev. Chapter 92 Level of evidence: Axial and coronal fat-suppressed proton density-weighted images demonstrate soft tissue edema surrounding the PTFJ with subtle irregularity of the posterior ligament (blue arrow) near the fibular attachment and an underlying bone contusion (arrowhead). Clin Imaging. sharing sensitive information, make sure youre on a federal Quantitative radiographic assessment of the anatomic attachment sites of the anterior and posterior complexes of the proximal tibiofibular joint. PMID: 29881700; PMCID: PMC5989917. Proximal Tibiofibular Joint Reconstruction With a Semitendinosus Allograft for Chronic Instability. Injuries to the joint are more commonly atraumatic and should be treated with surgery only after all other therapies have been exhausted. Successful diagnosis of the injury can be improved by a better understanding of the biomechanics of the joint and a clinical suspicion of the injury when symptoms are present. government site. Traumatic dislocations of the proximal tibiofibular joint are uncommon and are normally caused by high-energy injury or a fall on a twisted knee. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. Early diagnosis of this injury can prevent further injuries to the joint that are harder to treat, such as chronic or fixed subluxation. Warner B.T., Moulton S.G., Cram T.R., LaPrade R.F. I had wanted to do the Proximal Tibiofibular Surgery locally instead of flying out of state. The proximal tibiofibular joint should be palpated for tenderness, and laxity should be evaluated by translating the fibular head anteriorly and posteriorly with the thumb and index finger and asking the patient if the symptoms are reproduced or if there is any apprehension. 3D renders demonstrate posterior proximal tibiofibular reconstruction using LaPrades technique (12A). The reconstructive procedure is recommended for patients whose pain is a result of joint instability. Sequential axial (1A), coronal (1B), and sagittal (1C) fat-suppressed proton density-weighted images are provided through the proximal tibiofibular joint. In the past, chronic instability was treated with arthrodesis or fibular head resection; however, complications related to altered knee and ankle biomechanics rendered these options less desirable.13,14,15, As knee ligament reconstruction surgery has developed, various techniques to reconstruct the ligaments have been described. The examination of patients with atraumatic subluxation or chronic instability should be performed with the knee flexed to 90 degrees. eCollection 2022 Sep. Pappa E, Kakridonis F, Trantos IA, Ioannidis K, Koundis G, Kokoroghiannis C. Cureus. According to the Ogden classification, proximal tibiofibular joint injuries can be classified into the following subgroups 1-6: type 1: subluxation (more often in children and adolescents ) type 2: anterior dislocation (most common ~85%) type 3: posteromedial dislocation type 4: superior dislocation Radiographic features Plain radiograph With acute injury, patients usually complain of pain and a prominence in the lateral aspect of the knee. Traumatic dislocations commonly cause pain along the lateral knee that radiates into the region of the iliotibial band and the patellofemoral joint and is increased with palpation of the prominent fibular head and ankle motion. doi: 10.1016/j.eats.2022.08.052. A disruption of these ligaments is generally traumatic and could produce an abnormal . Epub 2017 Mar 20. Proximal Tibiofibular Joint (PTFJ): Stabilizing Tape Technique for Posterior Instability Twin Cities Orthopedics -Complex Knee Injury Clinic Jill Monson, PT, OCS Physical Therapy Team -Complex Knee Injury Clinic Twin Cities Orthopedics | Training HAUS Warnings With the knee flexed 90 the fibular head may be subluxed/dislocated by gentle pressure in an anterior or posterior direction. Arthrosc Tech. Axial images from superior to inferior demonstrate soft tissue edema surrounding the proximal tibiofibular joint. The examination of patients with atraumatic subluxation or chronic instability should be performed with the knee flexed to 90 degrees. Suspicion of atraumatic injury to the proximal tibiofibular joint warrants extensive inspection during the physical examination of the knee. It causes significant lateral sided knee pain and functional deficits and can be associated with up to 9% of multiligament knee injuries. The https:// ensures that you are connecting to the I am so glad I did! Rule out lateral meniscus tear. Dislocation of the proximal tibiofibular joint is a very uncommon condition that is easily misdiagnosed without clinical suspicion of the injury. Instability of the proximal tibiofibular joint (PTFJ) may be acute or chronic in etiology and four types of instability initially described by Ogden include anterolateral dislocation, posteromedial dislocation, superior dislocation, and atraumatic subluxation.1Anterolateral dislocation is by far the most common form of instability and the focus of this discussion. During significant trauma, traumatic dislocations of the tibiofibular joint are commonly missed, so the physical examination of this joint is a significant part of the comprehensive knee examination. Is stability of the proximal tibiofibular joint important in the multiligament-injured knee? This site needs JavaScript to work properly. A variety of surgical treatments have been proposed over the last decades. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. Surgical Management of Proximal Tibiofibular Joint Instability Using an Adjustable Loop, Cortical Fixation Device. Concurrent surgical treatment of posterolateral corner (PLC) and PTFJ instability poses technical challenges due to the limited working space . Suspicion of atraumatic injury to the proximal tibiofibular joint warrants extensive inspection during the physical examination of the knee. In the past, while others have often treated this instability of this joint by fusing it, we have reported through research that a proximal posterior tibiofibular joint ligament reconstruction is easily performed, does not overconstrain the joint and has decreased the chance of leading to ankle pathology further down the line. It can be associated with subtle instability and subluxation or frank dislocation of both the PTFJ and the native knee joint. 1998 Feb;84(1):84-7. In the setting of acute injury and subsequent stabilization, the posterior PTFJ ligaments have been shown to scar, thereby precluding the need for a full reconstruction.22 Moreover, the avulsion fracture portends bone-to-bone healing and any reconstruction technique requiring drilling through the posteromedial aspect of the fibular head risks comminuting and further displacing the fracture fragment. 2006 Mar;14(3):241-9. doi: 10.1007/s00167-005-0684-z. Proximal tibiofibular joint dislocation and instability is an easily overlooked cause of lateral knee pain. 2014 Sep;472(9):2691-7. doi: 10.1007/s11999-014-3574-1. Although many patients do not note symptoms during daily activities, symptoms may develop during activities that require sudden changes in direction. Bethesda, MD 20894, Web Policies Management of Proximal Tibiofibular Instability All I can say is Dr. La Prade did an amazing job and I am not limited in any of my activites. Ligament reconstruction using a semitendinosus tendon graft for proximal tibiofibular joint disorder: Case report. We recommend joint reconstruction to repair the proximal tibiofibular joint, which will retain the functional anatomy and rotation of the joint, over arthrodesis, especially in children and athletes. Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window) Instability of this joint may be in the anterolateral, posteromedial, or superior directions. A more definitive way to validate a diagnosis of proximal tibiofibular joint instability is with a taping program of the joint. Federal government websites often end in .gov or .mil. The Proximal Tibiofibular Joint: A Biomechanical Analysis of the Anterior and Posterior Ligamentous Complexes. Reconstructive procedures are recommended for patients whose source of pain is instability in the joint as opposed to arthritis. It often appears striated due to the presence of multiple bundles, and it is located just caudal to the anterior arm of the short head of the biceps femoris tendon. 2022 Sep 30;33(3):291-304. doi: 10.31138/mjr.33.3.291. On the lateral radiograph the fibular head barely intersects the radio-dense line (dotted line) representing the posteromedial margin of the lateral tibial condyle. The surgical treatment for proximal tibiofibular joint instability most often consists of an anatomic reconstruction of the torn ligaments. Thank you for choosing Dr. LaPrade as your healthcare provider. The condition is often missed, and the true incidence is unknown. More commonly, however, AP and lateral radiographs are performed (Figure 4). For the case discussed in Figure 9 above, stabilization with an adjustable loop cortical fixation device was selected for multiple reasons. Ogden JA. You can schedule an office consultation with Dr. LaPrade. 43 year-old male with lateral knee pain status-post snowboarding injury. Rev Chir Orthop Reparatrice Appar Mot. (including injections and arthroscopic surgery), I heard Dr. La Prade was going to practice in the Twin Cities - where I live, & waited for him, based on his renown reputation. LaPrade RF, Gilbert TJ, Bollom TS, Wentorf F, Chaljub G. The magnetic resonance imaging appearance of individual structures of the posterolateral knee. History and physical examination are very important for diagnosis. If one obtains the diagnosis soon after injury (acutely), immobilization of the knee in extension for a few weeks to try to get the posterior injured ligaments to heal is reasonable. The relative avascularity of the area of the proximal tibiofibular joint prevents the presentation of knee effusion with an isolated injury, but there may be a prominent lateral mass. Effects of a Partial Meniscectomy on Articular Cartilage, Femoral Condyle | Articular Cartilage Injury, FCL Injury or Lateral Collateral Ligament LCL Tear, Lateral Patellar Instability | MPFL Repair, Instability of the joint, especially during deep squatting, Concurrent irritation of the common peroneal nerve, because the common peroneal nerve crosses the lateral aspect of the fibular neck within 2-3 cm of the lateral aspect of the fibular head. This results in the fibula rotating away from the tibia during deep squatting. Instability of the proximal tibiofibular joint occurs when the ligaments which provide stability to this joint are injured. Proximal tibiofibular ligamentous abnormalities were present in 100% of acute (< 6 months) and 85.7% of chronic (>6 months) instability cases who underwent MRI. What are the findings? Clinical History: 21-year-old male with lateral knee pain radiating into the calf status-post soccer injury. PMID: 18647885. Protection of the peroneal nerve during surgery helps to prevent injury and relieves symptoms common to this injury. MeSH This answers all my questions! Espregueira-Mendes JD, da Silva MV. The treatment of proximal tibiofibular joint instability usually depends upon whether it is an acute or chronic injury. Instability of the joint can be a result of an injury to these ligaments. PMID: 27133689. The treatment of proximal tibiofibular joint instability depends upon the time of presentation. The implant is pulled through, flipping the medial button on the outside of the anteromedial cortex. 2019 Feb;27(2):412-418. doi: 10.1007/s00167-018-5061-9. The most (77% to 90%) PTFJ dislocations and instability were anterolateral/unspecified anterior dislocation or instability. Resnick D, Newell JD, Guerra J Jr, Danzig LA, Niwayama G, Goergen TG. Anterolateral dislocation commonly stems from injury to the anterior and posterior capsular ligaments, and commonly the lateral collateral ligament.1,2 The common cause of traumatic anterolateral dislocation is a fall on a flexed knee, or a violent twisting motion during an athletic activity.3 The hyperflexed knee results in relaxation of the biceps femoris tendon and the lateral collateral ligament, and the violent twisting of the body creates a torque that pushes the fibular head laterally to the edge of the lateral tibial metaphysis.1,2 The forced plantar flexion and ankle inversion forces the laterally displaced fibular head anteriorly.1 Zhongguo Gu Shang. The proximal tibiofibular joint should be palpated for tenderness, and laxity should be evaluated by translating the fibular head anteriorly and posteriorly with the thumb and index finger and asking the patient if the symptoms are reproduced or if there is any apprehension.4 The stability of the proximal tibiofibular joint is typically increased by full extension of the knee; if it is not, the lateral collateral ligament and posterolateral structures may also be injured. 2022;8:8. doi: 10.1051/sicotj/2022008. 1978 Jul;131(1):133-8. doi: 10.2214/ajr.131.1.133. HHS Vulnerability Disclosure, Help Most commonly, hamstring allografts and autografts are used to reconstruct the proximal tibiofibular joint anatomically. Fibular resection during an arthrodesis procedure can decrease ankle pain and instability after surgery. Reconstructive procedures are recommended for patients whose source of pain is instability in the joint as opposed to arthritis. The diagnosis of joint instability can be confirmed by steroid and local anesthetic injection into the joint under fluoroscopic guidance, if pain is relieved. Repair with bicortical suspension device restores proximal tibiofibular joint motion. Anatomic reconstruction of chronic symptomatic anterolateral proximal tibiofibular joint instability. Patients with subluxation of the proximal tibiofibular joint commonly report pain over the joint that is aggravated by direct pressure over the fibular head. PMID: 20127312. Clin Orthop Relat Res. Reconstruction is recommended to maintain correct anatomic function and rotation of the joint. Epub 2017 Mar 24. Inclusion criteria were as follows: PTFJ instability treatment techniques, PTFJ surgical outcomes, English language, and human studies. To evaluate the treatment options, outcomes, and complications associated with proximal tibiofibular joint (PTFJ) instability, which will aim to improve surgical treatment of PTFJ instability and aid surgeons in their decision making and treatment selection.