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Posterior ligament of fibular head

The posterior ligament of the fibular head is a fibrous band reinforcing the posterior aspect of the proximal tibiofibular joint. It provides joint stability by preventing excessive anterior or posterior displacement of the fibular head relative to the tibia. Though small, it is clinically important in the evaluation of knee injuries, posterolateral corner injuries, and proximal fibular fractures.

Synonyms

  • Posterior proximal tibiofibular ligament

  • Posterior fibular head ligament

  • Posterior tibiofibular capsular ligament

Attachments

  • Proximal attachment: Posterior aspect of the fibular head

  • Distal attachment: Posterior surface of the lateral condyle of the tibia

  • Fibers blend partially with the capsule of the proximal tibiofibular joint

Relations

  • Anteriorly: Capsule of the proximal tibiofibular joint

  • Posteriorly: Popliteus tendon and popliteal vessels (deeper)

  • Superiorly: Lateral tibial condyle

  • Inferiorly: Fibular shaft

  • Laterally: Biceps femoris tendon inserting onto fibular head

  • Medially: Posterior tibial plateau and interosseous membrane origin

Nerve Supply

  • Supplied by branches of the common peroneal nerve and tibial nerve (sensory articular twigs to proximal tibiofibular joint)

Arterial Supply

  • Inferior lateral genicular artery

  • Recurrent branches of anterior tibial artery

Venous Drainage

  • Corresponding veins draining into the anterior tibial and popliteal venous systems

Function

  • Reinforces the posterior capsule of the proximal tibiofibular joint

  • Prevents posterior subluxation of the fibular head

  • Contributes to posterolateral stability of the knee

  • Provides resistance during twisting or shearing stresses at the fibular head

Clinical Significance

  • May be injured in proximal fibular fractures, posterolateral corner injuries, or knee dislocations

  • Injury can cause instability of the proximal tibiofibular joint and lateral knee pain

  • Important landmark in surgical exposures of the fibular head and lateral knee

  • MRI evaluation helps detect sprains, tears, or capsular disruptions

MRI Appearance

T1-weighted images:

  • Ligament appears as a thin low-signal band from fibular head to tibial condyle

  • Surrounded by bright fat, improving visibility

T2-weighted images:

  • Normal ligament shows dark low signal

  • Sprains or partial tears appear as focal hyperintense regions within the ligament

STIR (Short Tau Inversion Recovery):

  • Ligament remains dark

  • Injury, edema, or inflammation shows bright hyperintensity

Proton Density Fat-Saturated (PD FS):

  • Normal ligament: dark low signal

  • Partial tear, strain, or periligamentous edema: bright hyperintensity

T1 Fat-Sat Post-Contrast:

  • Normal ligament enhances minimally, if at all

  • Inflamed or torn ligament shows focal or diffuse enhancement, sometimes with periligamentous enhancement

CT Appearance

Non-Contrast CT:

  • Ligament not directly visible, inferred as a soft tissue density at the posterior fibular head

  • Calcification or avulsion fracture at attachment may be seen

Post-Contrast CT:

  • Normal ligament shows no significant enhancement

  • Pathology (inflammation, tumor infiltration) may appear as soft tissue thickening or enhancing density around fibular head

MRI images

Posterior ligament of fibular head axial cross sectional anatomy 3T MRI AI enhanced radiology anatomy image-img-00000-00000

MRI images

Posterior ligament of fibular head sagittal cross sectional anatomy 3T MRI AI enhanced radiology anatomy image-img-00000-00000