The posterior tibiofibular recess is a synovial extension of the ankle joint that projects proximally between the posterior tibia and fibula, behind the posterior inferior tibiofibular ligament and inferior transverse ligament. It is the most posterior component of the ankle joint and is assessed arthroscopically via the posterolateral portal.
The posterior tibiofibular recess may contain loose bodies, synovial impingement, and posterior ankle impingement lesions. It is the surgical target in os trigonum removal and posterior ankle impingement release via the posterior arthroscopic approach. Posterior ankle pain at terminal plantarflexion that fails to improve with conservative treatment warrants posterior ankle arthroscopy to assess this recess.
Compression of the posterior tibiofibular recess contents (os trigonum, posterior talar process, or hypertrophied posterior capsule) in maximal plantarflexion producing posterior ankle pain, treated by arthroscopic posterior ankle debridement.
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