Working Diagnosis:
Subluxation of the left tibia fibular joint.

Treatment:
She was initially managed conservatively. She was previously started on Non steroidal anti inflammatory medications, began rest and ice. She also had multiple week trials of aggressive physical therapy. They also used stabilizing taping techniques.

She was eventually referred to to our sports medicine clinic for further treatment options. She was given a series of 3 Ultrasound-Guided Prolotherapy Injections of tibia fibular joint capsule. The idea behind this, is to use the inflammatory and healing process involved in prolotherapy to tack down and scar down the joint capsule and surrounding ligamentous structures (Proximal, Anterior and Posterior Tibia fibular ligaments).

After the second of 3 Ultrasound-Guided Prolotherapy Injections, she was also referred back to physical therapy in order to help with muscle reeducation and strengthening of the muscular tendon structures that help stabilize the tibia fibular joint.

Outcome:
After a series of three Ultrasound-Guided Prolotherapy Injections of tibia fibular joint capsule, over a span of 4 months. We used the patient's testimonial and self assessment of her subluxation and our physical exam for outcome measures. After each subsequent follow up, patient described improved stability and decreased in episodes of subluxation. We also noted improvement in stability and tenderness at each visit.

The patient has successfully made a gradual return to her daily activities, including walking, ambulating stairs, and playing with her grandchildren without pain or instability of her proximal lower leg.

Author's Comments:
Tibia fibular subluxation is a rare cause of lateral knee pain and instability. Typically this is managed conservatively with rare cases requiring surgical intervention. With the emergence of regenerative medicine injection techniques and the addition ultrasound guidance, we are able to further treat refractory cases. This case shows the successful diagnosis and management of a Tibia fibular subluxation in an active older female allowing successful return to daily activities.

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