A 25-year-old male player presented with localised lateral knee pain. He thinks that this might have started when he slipped and twisted his knee while training. He was however able to continue to train and did not develop pain until a few days after this injury.
On examination, he was found to have localised tenderness over the superior tibiofibular joint (STFJ) as well as some stiffness ‘gliding’ the joint (when compared with the contralateral side). There was an otherwise normal knee and ankle examination.
A lateral x-ray series is normal, with no evidence of STFJ instability or knee pathology. A coned, oblique view profiling the STFJ is illustrated here. A focal area of cartilage fissuring is suspected involving the fibular head and tibia at the superior tibiofibular joint. A small amount of T2 intermediate signal is present in the fibular head and the tibia at the SJFJ which likely reflects focal articular cartilage damage. The remainder of the knee, including the lateral meniscus and lateral compartment, is normal.
This player was successfully treated with a short period of rest, mobilisation of the STFJ, oral NSAID and taping of the injured joint. With this regime his symptoms slowly resolved over a three-month period. He was able to continue to play and train throughout his treatment.
The STFJ is an inherently stable structure. As a result, injuries to the STFJ are uncommon, accounting for less than 1% of all knee injuries. They can occur in isolation or in combination with other bony and ligamentous injuries such as tibial shaft fractures. The most widely reported injury ‘type’ is a subluxation or dislocation. The joint can also become painful more insidiously (as this case likely illustrates). In this situation it is often hypomobile and can create problems at both the knee and ankle joint.
The most commonly reported symptom is pain related to the lateral knee. Localised tenderness and pain with gliding or moving the joint are the most common examination findings. Given that the common peroneal nerve lies adjacent to the STFJ, patients may also have more diffuse symptoms or signs relating to injury or irritation of this structure.
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