Proximal Tibiofibular Joint Stabilization Using an Adjustable-Length Suspensory Fixation Device

Abstract

Background: Proximal tibiofibular joint (PTFJ) injuries are rare injuries, and the optimal treatment is poorly understood. Surgical treatment options for PTFJ instability include reconstruction with allograft, stabilization with an adjustable-ength suspensory fixation device, open reduction and internal fixation with a screw, arthrodesis, and proximal fibular resection. Indications: In acute first-time PTFJ dislocations, nonoperative treatment may be trialed after closed reduction. Operative treatment is indicated for first-time dislocation with concomitant operative injury, an irreducible dislocation, and chronic symptomatic PTFJ instability. Taping or PTFJ injections can be helpful for diagnostic and therapeutic purposes and should be trialed before moving forward with surgical treatment. Technique Description: Multiple PTFJ stabilization and reconstruction techniques have been described for PTFJ instability. This technique describes a stabilization technique utilizing an adjustable-ength suspensory fixation device that is placed through a posterolateral approach to the knee. Results: A prior systematic review of PTFJ injuries found that approximately 59% of patients with a PTFJ dislocation were successfully treated nonoperatively with no symptoms at a mean final follow-up of 15.9 months. While multiple case reports and techniques have been reported for PTFJ stabilization using an adjustable-ength suspensory fixation device, there are limited data on outcomes of this procedure. Discussion/Conclusions: PTFJ stabilization using an adjustable-ength suspensory fixation device is a safe and technically feasible option for the treatment of PTFJ instability. It is critical to confirm the diagnosis of symptomatic PTFJ instability with either a taping trial or a diagnostic injection before proceeding with surgical treatment. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.