Bilateral, Atraumatic Proximal Tibiofibular Joint Instability Treated With Suspensory Button Fixation

Abstract

Proximal tibiofibular joint (PTFJ) instability is a rare cause of lateral-sided knee pain. The authors present a case of bilateral, symptomatic PTFJ instability with peroneal nerve dysfunction in an active 16-year-old female athlete. This was addressed with peroneal nerve decompression and PTFJ stabilization using a suspensory button fixation system. This provides an alternative treatment from historical methods such as PTFJ fusion or re-approximation of the joint with tendon through bone tunnels. The surgical technique, as well as potential treatment challenges, is described in detail. The purpose of this report is to highlight PTFJ instability as a cause of lateral-sided knee pain to avoid misdiagnosis and delay in appropriate treatment. This patient had significant improvement in pain and decreased neurologic symptoms after the stabilization and nerve decompression. She was able to return to high-level activity. [Orthopedics. 2017; 40(6):e1107-e1111.].

Proximal Tibiofibular Joint Reconstruction With a Semitendinosus Allograft for Chronic Instability

“… 8 , 11 , 16 Different techniques for soft-tissue reconstruction of the PTFJ have recently been described, including the use of nonanatomic rerouting procedures (including the biceps femoris or ITB) and free autografts for anatomic reconstruction. 8 , 18 , 19 , 20 Considering that nonanatomic procedures are associated with abnormal biomechanics, resulting in overconstraint or constructs prone to stretching out over time, anatomic-based reconstruction is preferred. In the aforementioned systematic review by Kruckeberg et al., 8 graft reconstruction led to improved pain and International Knee Documentation Committee (IKDC) scores, with low complication rates.…”

Proximal Tibiofibular Joint Instability: An Underrecognized Cause of Lateral Knee Pain and Mechanical Symptoms

“…21 These symptoms are typically transient and worsened by knee flexion, although symptoms may eventually occur at rest. 22…”

“…Alternatively, some have recommended using suture button fixation in the acute setting to achieve stable reduction without the need for fusion and a second procedure for implant removal. 22,30…”

Surgical Management of Concomitant Proximal Tibiofibular Instability and Medial Collateral Ligament Tear: A Case Report

“…Proximal tibiofibular joint (PTFJ) instability is a rare injury that requires a high index of suspicion for diagnosis with lateral-sided knee pain [ 1 ]. These injuries often occur in patients with high-energy mechanisms and can been seen with a concomitant tibial shaft fracture [ 2 , 3 , 4 ] However, cases of isolated proximal tibiofibular dislocations have also been described [ 5 ]. Patients often present with lateral-sided knee pain, similar to numerous other pathologies of the knee, making the diagnosis difficult and frequently missed.…”

“…Historically, fusion and screw fixation methods were used; however, the PTFJ plays a role in internal and external rotation of the leg, making these stiffer construct less desirable [ 6 ]. More recent advancements in the surgical treatment of these injuries include either an anatomic graft reconstruction or suspensory button fixation [ 5 , 7 , 8 ].…”