Role of proximal tibiofibular fixation in leg lengthening with the Ilizarov method in the achondroplastic patient

Abstract

The role of proximal tibiofibular joint (TFJ) transfixion during Ilizarov tibial lengthening is still debated in the literature. The aim of this study was to show that TFJ transfixion can be avoided with no impact on patient outcome. All achondroplastic patients undergoing tibia lengthening from 1999 to 2018 were included. Patients were divided in two groups: group A (11 patients) submitted to proximal TFJ transfixion and group B (22 patients) not submitted to TFJ transfixion. The results showed a statistically significant difference in proximal fibular migration (PFM) between the two groups of patients, with a mean PFM of 9.2 mm (range, 1-20 mm) and of 21 mm (range, 2.7-76 mm) in group A and in group B, respectively. We can state that PFM up to 41 mm in our series did not affect joint function and stability. There are no statistically significant differences in the other radiological parameters. Analysis of functional scores (Knee Society, Tegner-Lhysolm, Association for the Study and Application of Methods of Ilizarov) did not reveal significant differences between the groups. The scores of the Achondroplasia Personal Life Experience Scale were also similar in the two groups, demonstrating a good quality of life. There are no differences between the two groups in terms of clinical-functional outcome of the knee, radiographic results, and quality of life. Transfixion of proximal TFJ may not be necessary, but it is important to avoid premature consolidation of the fibular osteotomy.

Comparative fixation devices for preventing migration of the proximal tibiofibular joint during tibial lengthening: a tether versus screw fixation

“…This is the first study regarding the use of a tether fixation of the proximal tibiofibular joint during tibial MILN lengthening, thus the discussion will focus on related literature addressing similar clinical scenarios. Numerous studies demonstrated distal migration of the fibular head during lengthening [ 7 – 14 ], with greater distance migrated consistently observed when the tibiofibular joint had no fixation [ 10 ]. However, Song et al [ 15 ] demonstrated that fibular migration could occur even if the joint is fixed with a tensioned wire.…”

“…Proximal fibula migration can be associated with clinically meaningful symptoms. Boero et al demonstrated no association between proximal fibular migration up to 41 mm with worsening knee function or malalignment [ 10 ]. This may be due to the gradually elongated proximal tibiofibular joint capsule [ 13 ].…”

What’s new in pediatric lower limb reconstruction?

“…57 In contrast to femoral lengthening with internal devices, Rovira Martí et al 57 confirmed that prophylactic intramedullary rodding should be considered to prevent regenerate re-fracture after femoral lengthening using external fixators in patients with achondroplasia. In tibial lengthening with Ilizarov fixator, Boero et al 58 measured proximal migration of the fibular head when proximal tibiofibular fixation was not performed as opposed to when it was performed. However, this did not lead to differences in the clinical-functional outcome of the knee, radiographic results, and quality of life.…”

What’s New in Limb Lengthening and Deformity Correction

“…Balci et al evaluated the results of simultaneous lengthening compared with consecutive lengthening of the femur and tibia in 26 patients with achondroplasia and determined that, although the difference was not significant, simultaneous bilateral femoral and tibial lengthening resulted in a greater disturbance of physeal growth 23 . Boero et al analyzed functional and quality-of-life scores to assess the effect of fixation of the proximal tibiofibular joint during Ilizarov external fixator lengthening of the tibia in a cohort of patients with achondroplasia 24 . Despite a significant difference in the magnitude of migration of the proximal tibiofibular joint (9.2 mm for the fixation group compared with 21 mm for the non-fixation group), the functional and quality-of-life scores were not related to fixation of the proximal tibiofibular joint.…”