Proximal Tibiofibular Joint Instability and Treatment Approaches: A Systematic Review of the Literature

Kruckeberg, Bradley M.; Cinque, Mark E.; Moatshe, Gilbert; Marchetti, Daniel Cole; DePhillipo, Nicholas N.; Chahla, Jorge; LaPrade, Robert F.

doi:10.1016/j.arthro.2017.03.027

Cited by 39 publications

(81 citation statements)

References 44 publications

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“…1 Nonoperative treatment through immobilization has been reported in 35 patients, which resulted in improvement without persistent symptoms in 59% of patients. 2 Various fixation methods have been reported in the literature, including internal fixation with screw, free graft reconstruction, and cortical button suspensory fixation. 2 Kruckeberg et al 2 performed a systematic review wherein 16 patients were treated with screw alone and 62.5% of patients reported no instability with fixation.…”

Section: Discussionmentioning

confidence: 99%

“…2 Various fixation methods have been reported in the literature, including internal fixation with screw, free graft reconstruction, and cortical button suspensory fixation. 2 Kruckeberg et al 2 performed a systematic review wherein 16 patients were treated with screw alone and 62.5% of patients reported no instability with fixation. Fibular head resection was performed in 8 patients, and resulted in no instability symptoms; however, 1 patient had persistent temporal peroneal nerve palsy.…”

Section: Discussionmentioning

confidence: 99%

“…Fibular head resection was performed in 8 patients, and resulted in no instability symptoms; however, 1 patient had persistent temporal peroneal nerve palsy. 2 Alternative reconstructive options include free graft and a suture bridge construct. 5 In patients receiving free graft reconstruction, none had instability symptoms; however, 2 patients were reported to have sustained a fracture perioperatively.…”

Section: Discussionmentioning

confidence: 99%

“…1 A myriad of operative treatment options exists to treat PTFJ instability with low complication rates, relief of symptoms, and improved outcomes; however, there is no established optimal treatment modality. 2 Cortical button suspensory devices fixation has increasingly been used for the stabilization of tibiofibular instability, both distally and to a lesser extent proximally, given their strong biomechanical properties and limited bulk. 3,4 The present technical report presents a cross country athlete with atraumatic, subacute onset of PTFJ instability with common peroneal nerve symptoms.…”

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confidence: 99%

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Cortical Button Fixation for Proximal Tibiofibular Instability: A Technical Report

Beck

Gowd

Nabor

et al. 2020

Arthroscopy Techniques

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Instability of the proximal tibiofibular joint (PTFJ) is a rare injury pattern than can affect high-demand athletes involved in twisting or pivoting movements on a flexed knee. Instability may produce painful subluxations during provocative activity and occasional neuritic symptoms from tethering of the common peroneal nerve at the fibular neck. There are several reports of reconstruction for symptomatic PTFJ instability; however, no optimal treatment has been elucidated in the literature. Use of a cortical button suspensory device for fixation of the PTFJ offers the advantage of stabilizing the joint without need for free graft harvest or rigid screw fixation. The present technical report illustrates the operative technique and the advantages, disadvantages, pearls, and pitfalls associated with this operation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Cortical Button Fixation for Proximal Tibiofibular Instability: A Technical Report

Beck

Gowd

Nabor

et al. 2020

Arthroscopy Techniques

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“…More recent publications have migrated to techniques emphasizing anatomic reconstruction procedures. 4 , 5 , 6 , 7 With the majority of PTFJ instability occurring in the anteromedial direction, Warner et al. 7 advocated for the restoration of solely the single, thin-banded posterior ligament, 8 as opposed to techniques that additionally reconstruct the anterior ligaments, 4 , 6 which could overconstrain the PTFJ.…”

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confidence: 99%

Proximal Tibiofibular Reconstruction in Adolescent Patients

Kennedy

DePhillipo

Moatshe

et al. 2018

Arthroscopy Techniques

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Instability of the proximal tibiofibular joint (PTFJ) can present as frank dislocations, vague symptoms of lateral knee pain, discomfort during activity, or symptoms related to irritation of the common peroneal nerve. An accurate preoperative diagnosis is imperative and should include a trial of taping of the PTFJ for a 4- to 6-week time frame before surgical reconstruction is indicated. In the adolescent population, surgical planning can be complicated by the presence of open physes; therefore, caution must be taken to avoid drilling through or placing screw fixation across the physes. Potential complications include growth arrest and limb length discrepancy. Therefore, the purpose of this Technical Note is to describe the surgical technique for addressing PTFJ instability in adolescent patients.

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