The superior tibiofibular joint is an arthrodial-type joint, which allows a very limited range of motion. The joint is comprised of the articulations between the lateral condyle of the tibia and the head of the fibula (Fig. 137.1). The joint’s articular cartilage is susceptible to damage, which, if left untreated, will result in arthritis with its associated pain and functional disability. Osteoarthritis of the joint is the most common form of arthritis that results in superior tibiofibular joint pain and functional disability, with rheumatoid arthritis and posttraumatic arthritis also causing arthritis of the superior tibiofibular joint. The tibiofibular joint frequently is damaged from falls with the foot fully medially rotated and the superior tibiofibular joint flexed. Less common causes of arthritis-induced superior tibiofibular joint pain include the collagen vascular diseases, infection, villonodular synovitis, and Lyme disease. Acute infectious arthritis of the superior tibiofibular joint is best treated with early diagnosis, with culture and sensitivity of the synovial fluid, and with prompt initiation of antibiotic therapy. The collagen vascular diseases generally manifest as a polyarthropathy rather than a monoarthropathy limited to the superior tibiofibular joint, although superior tibiofibular pain secondary to the collagen vascular diseases responds exceedingly well to ultrasound-guided intra-articular injection of the superior tibiofibular joint. The superior tibiofibular joint is a common site of ganglion cysts.

Patients with superior tibiofibular joint pain secondary to arthritis and collagen vascular disease-related joint pain complain of pain that is localized to the superior tibiofibular joint and lateral knee. Activity, especially involving flexion and medial rotation of the superior tibiofibular joint, makes the pain worse, with rest and heat providing some relief. The pain is constant and characterized as aching. Sleep disturbance is common with awakening when the patient rolls over onto the affected superior tibiofibular. Some patients complain of a grating, catching, or popping sensation with range of motion of the joint, and crepitus may be appreciated on physical examination.

Functional disability often accompanies the pain associated with many pathologic conditions of the superior tibiofibular joint. Patients will often notice increasing difficulty in performing their activities of daily living, and tasks that require walking, climbing stairs, and walking on uneven surfaces are particularly problematic. If the pathologic process responsible for the patient’s pain symptomatology is not adequately treated, the patient’s functional disability may worsen and muscle wasting may occur.

Plain radiographs are indicated in all patients who present with superior tibiofibular pain as not only intrinsic superior tibiofibular disease but also other regional pathology may be perceived as superior tibiofibular pain by the patient. Based on the patient’s clinical presentation, additional testing may be indicated, including complete blood cell count, sedimentation rate, and antinuclear antibody testing. Magnetic resonance imaging, computed tomography (CT), or ultrasound of the superior tibiofibular joint is indicated if avascular necrosis or meniscal tear is suspected or if the diagnosis is unclear (Figs. 137.2 and 137.3).

The lateral epicondyle of the tibia and the head of the fibula articulate at the superior tibiofibular joint (see Fig. 137.1). The flattened articular surfaces are covered with hyaline cartilage, which is susceptible to arthritis. The joint is completely surrounded by a capsule that provides support to the joint. Anterior and posterior ligaments strengthen the joint as does the interosseous membrane, which connects the shafts of the tibia and fibula together (Fig. 137.4). The joint capsule is lined with a synovial membrane that attaches to the articular cartilage and may give rise to bursae. The tibiofibular joint is innervated by the common peroneal nerves. The blood supply to the tibiofibular joint is provided by the inferior lateral genicular and anterior fibula recurrent arteries. In addition to arthritis, the tibiofibular joint is susceptible to the development of tendonitis, bursitis, and disruption of the ligaments, cartilage, and tendons.