Sometimes the varus stress test will be painful as the lateral ligament attaches to the fibular head. The superior tibiofibular joint is a modified ovoid synovial joint that works in concert with the inferior joint. The combination of both joints forms a functional modified sellar with one degree of freedom, pronation and supination. Pronation occurs when the tibia and fibular rotate medially causing the two bones to cross each other. At the superior joint the fibular glides superoposteromedial.
Supination is the opposite.
The posterior subluxation is characterized by a reduction of the anterolateral glide and the anterior subluxation by a reduced posteromedial glide. The anterior subluxation is reduced by a posterior manipulation. The patient is laid supine with the leg rotated inwards to bring the anterolateral-posteromedial joint line vertical. The medial aspect of the knee is supported with a sandbag to prevent a valgus stress being induced during the manipulation. The therapist stabilizes the tibia with the medial hand and places the pisiform area of the other hand over the anterior aspect of the fibular head and thrusts directly downwards into the bed.