Proximal Tibiofibular Joint Stabilization With Concurrent Posterolateral Corner Reconstruction in Multiligamentous Knee Injury

ABSTRACT: Proximal tibiofibular joint (PTFJ) instability is a rare knee injury, accounting for less than 1% of knee injuries. It causes significant lateral sided knee pain and functional deficits and can be associated with up to 9% of multiligament knee injuries. Concurrent surgical treatment of posterolateral corner (PLC) and PTFJ instability poses technical challenges due to the limited working space of the fibula head and inherent risk of collision between grafts, bone tunnels, and implants. In this Technical Note, we detail our senior author’s technique for PTFJ reconstruction without the use of additional bone tunnels or implants in the fibula head, to reduce the risk of overcrowding and tunnel collision.

Classifications

Level I: knee; Level II: other, proximal tibiofibular joint. Technique Video Video 1 Our technique for left knee proximal tibiofibular joint (PTFJ) stabilization with concomitant posterolateral corner (PLC) reconstruction is described in a stepwise manner. A lateral incision is first made with the knee in extension. The knee is subsequently flexed, and a posterior flap is raised. The peroneal nerve is identified and neurolyzed, and its entry to the lateral leg compartment is decompressed. Soft tissue around the fibula head is released. The fibula tunnel is reamed and directed 30° in a posteromedial and proximal directions. The Ultrabraid sutures are threaded through the tunnel, followed by the PLC reconstruction graft. The anterior and posterior loops of the Ultrabraid suture are tunneled under the soft tissue on the lateral fibula head. The posterior loop sutures are threaded into the 5.5-mm Footprint Ultra PK anchor and deployed at the posterior tibia at the level and adjacent to the fibula head. This step is repeated for the anterior loop sutures, and the anchor is deployed at the anterior tibia at the level and adjacent to the fibula head. The stability of the PTFJ reconstruction is checked, and the surgeon proceeds with the subsequent PLC reconstruction.

SUBMITTER: Yuen W 

PROVIDER: S-EPMC8626619 | biostudies-literature |

REPOSITORIES: biostudies-literature