Surgical Treatment Of Proximal Tibiofibular Joint Instabilit
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Injuries of the proximal tibiofibular joint were estimated that proximal tibiofibular joint instability is present in up to 9% of multiligament knee injuries. Anterolateral instability is the most common type and is caused by a mechanism involving knee flexion, foot inversion, and plantarflexion . Patients often present with pain, tenderness to palpation, swelling, locking or popping sensation, hypermobility, and limited ability to bear weight. Surgical treatment is indicated in cases of chronic dislocation, chronic pain, symptomatic instability, or failed conservative treatment . A number of techniques have been presented for surgical treatment of proximal tibiofibular joint instability. However, there is currently no consensus for the best technique.

Here presented the case of a 46-year-old male with a several year history of a painful popping sensation about the right lateral knee with squatting, kneeling, or sitting for a prolonged period and a persistent altered sensation from the lateral leg to anterior ankle. Surgical history included a high tibial osteotomy eight years prior to the presentation, posterolateral corner and lateral collateral ligament reconstruction five years prior to the presentation with hardware removal two years later, and three separate common peroneal nerve decompressions prior to the presentation.

The patient demonstrated full active range of motion at the knee and negative ligamentous testing. Increased mobility with pain of the proximal fibula was elicited in an anterolateral to posteromedial direction. Hypoesthesia was present from the lateral leg extending to the dorsal ankle.Radiographs showed evidence of prior procedures consistent with his history and one metallic screw retained in the tibia. The fibula appeared in posteromedial alignment with a double trochoid articular facet. Nerve conduction velocity and electromyography study results were normal.

Noncontrast computed tomography and magnetic resonance imaging showed the following: chronic rupture of the proximal lateral collateral ligament; screw tracks in the lateral, posterior, and proximal tibial metaphysis and lateral femoral condyle; graft construct beginning at the posterior margins of the lateral tibial condyle extending to the lateral femoral condyle; rupture of the posterolateral corner graft construct; chronic partial tearing of the popliteus tendon; scar remodeling of the popliteal fibular ligament; and a prominent 1 cm × 2.7 cm postsurgical bone spur at the proximal tibial metaphysis in the region of the screw tracks.

In summary, the surgical technique described in the current case report used dynamic fixation with two TightRopes in diverging fashion and bioabsorbable screw fixation. This procedure can be performed with basic surgical instruments at relatively low risk to the patient, and should be considered for surgical treatment of proximal tibiofibular joint instability that does not respond to conservative treatment.

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