Communications between the tibiofemoral and superior tibiofibular joints (STFJ) have been thought to be infrequent. Previous anatomic studies have revealed these in only 10–64% of cases. In this study, the authors reviewed the results of direct knee arthrography performed in 17 consecutive patients from January 2010 to July 2011 with various knee or STFJ-related pathologies. In all 17 consecutive cases, the authors demonstrated evidence of knee and STFJ communications. The authors believe that high-resolution imaging arthrography, especially with physiological loading and delayed imaging, can demonstrate these communications more consistently than unenhanced anatomic studies. Clin. Anat. 2013. © 2012 Wiley Periodicals, Inc.