Berna Dirim MD, Presenter: Nothing to Disclose

Mani Wangwinyuvirat MD, Abstract Co-Author: Nothing to Disclose

Daniel Pastore MD, Abstract Co-Author: Nothing to Disclose

Michael L Pretterklieber MD, Abstract Co-Author: Nothing to Disclose

Parviz Haghighi MD, Abstract Co-Author: Nothing to Disclose

Debbie Trudell, Abstract Co-Author: Nothing to Disclose

Donald L. Resnick MD, Abstract Co-Author: Nothing to Disclose

The anatomy and functional importance of the proximal tibiofibular joint (PTFJ) and specifically,the communication between the PTFJ and the knee have been rarely emphasized in the literature.In a few recent studies; the frequency of such communication has been reported to be between 10% and 64%, although the anatomic basis for the finding has not been defined. This study was performed in order to analyze the frequency and pattern of the communication between these two articulations in cadavers and also in clinical cases of acute anterior cruciate ligament (ACL) tears.

Twelve fresh cadaveric knees were studied with 1.5 Tesla magnetic resonance (MR) imaging and MR artrography. For anatomic analysis, cadaveric specimens were frozen and sectioned in 2-mm-thick slices in sagittal, axial and coronal planes. MR images and anatomical specimens were evaluated in consensus by two musculoskeletal radiologists. MR imaging examinations in 43 knees of patients with arthroscopically proven acute ACL tears were reviewed to demonstrate possible injury about the PTFJ.

In 3 of 12 specimens (25%), communication between the knee and the PTFJ was demonstrated via the subpopliteal recess (SR) related to a defect in the posterior ligament of the fibular head (PLFH). The SR was the inferior extension of the joint cavity of the knee and was found more inferiorly than the popliteal hiatus. The PLFH was covered by the SR and was best seen in sagittal images. Findings suggesting injury to the posterolateral corner of the knee were evident in one of these three specimens (33%). Review of MR images in patients with ACL tears documented disruption of PLFH and communication between these two articulations in 3 of 43 cases (7%).

In cadavers, 25% of the PTFJ communicated with the knee joint via the SR related to a defect in the PLFH; 7% of patient with arthroscopically confirmed acute tear of the ACL had such communication. Injury to the PLFH and possible instability of the PTFJ may occur in association with posterolateral corner injury.

Knowledge of the anatomy and MR imaging of the PLFH and SR is key to identifying injuries to these structures that lead to communication between the knee and PTFJ.

Dirim, B, Wangwinyuvirat, M, Pastore, D, Pretterklieber, M, Haghighi, P, Trudell, D, Resnick, D, Anatomic Basis and Clinical Significance of Communication between the Proximal Tibiofibular Joint and the Knee via the Subpopliteal Recess: MR Arthrographic Study with Gross Pathologic and Histologic Correlation in Cadavers.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5002869.html