Authors: Michael Jabara Jeffrey Bradley Michael Merrick
Publish Date: 2014/03/25
Volume: 472, Issue: 9, Pages: 2691-2697
Abstract
The incidence of proximal tibiofibular joint instability in the setting of the multiligamentinjured knee has not been previously reported The integrity of the proximal tibiofibular joint is required to perform a fibularbased lateralsided knee reconstructionWe report 1 the frequency of proximal tibiofibular joint instability in patients presenting with multiligament knee injuries and evaluate 2 our ability to restore stability to this joint 3 patientreported outcome scores and 4 complications in patients surgically treated for proximal tibiofibular joint instability at the time of treatment of multiligament knee instabilityFrom 2005 to 2013 124 patients 129 knees sustaining multiligament knee injuries with Grade 3 instability to at least two ligaments were treated at our institution We defined proximal tibiofibular joint instability as a dislocated or dislocatable proximal tibiofibular joint at the time of surgery These patients underwent surgery to restore proximal tibiofibular joint stability and ligament reconstruction or repair and were followed with routine clinical examination radiographs and subjective outcome measures including Lysholm and IKDC scores Minimum followup was 12 months mean 32 months range 12–61 monthsTwelve knees 12 patients 9 of 129 knees showed proximal tibiofibular joint instability Knee stability in 10 patients was restored to Grade 1 or less in all surgically treated ligaments No proximal tibiofibular joint instability has recurred No patients have complained of ankle stiffness or pain In the ten patients with subjective scores mean Lysholm score was 75 range 54–95 and mean IKDC score was 58 range 22–78 There were four complications one failed posterolateral corner reconstruction one proximal tibiofibular joint screw removal secondary to pain over the screw head one deep infection treated with serial irrigation and débridements with graft retention and one closed manipulation secondary to arthrofibrosis and loss of ROMIn the setting of multiligamentinjured knees our series demonstrated a 9 incidence of proximal tibiofibular joint instability The technique we describe successfully restored stability to the proximal tibiofibular joint and resulted in satisfactory patientreported outcomes with low complication ratesEach author certifies that he or she or a member of his or her immediate family has no funding or commercial associations eg consultancies stock ownership equity interest patent/licensing arrangements etc that might pose a conflict of interest in connection with the submitted articleClinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment drug or device Readers are encouraged to always seek additional information including FDA approval status of any drug or device before clinical useEach author certifies that his or her institution approved the human protocol for this investigation that all investigations were conducted in conformity with ethical principles of research and that informed consent for participation in the study was obtained
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