The superior tibiofibular recess is a synovial extension of the proximal tibiofibular joint that may communicate with the knee joint in 10% of individuals through the popliteus bursa. It allows slight anteroposterior glide of the fibular head and is the site of ganglion cyst formation causing peroneal nerve compression.
Superior tibiofibular joint ganglion cysts arise from this recess and compress the common peroneal nerve at the fibular neck, producing progressive foot drop. MRI demonstrates the cyst communicating with the joint. Aspiration under ultrasound guidance provides temporary relief; surgical excision with joint communication closure is definitive. The recess communicates with the knee joint in type I (anterolateral) configuration via the popliteus recess.
Synovial cyst from the superior tibiofibular recess compressing the common peroneal nerve at the fibular neck, producing progressive foot drop requiring cyst excision and nerve decompression.
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