Stabilization of chronic proximal tibiofibular joint instability with a semitendinosus graft

Although chronic proximal tibiofibular joint instability is a rare condition, it is associated with marked functional impairment. Various surgical options have been reported in literature, all associated with several problems and limitations. We describe a new technique of reconstruction of the proximal tibiofibular joint using the semitendinosus tendon. The key steps of the procedure are the preparation of a proximally released semitendinosus tendon, and its guidance through two transtibial tunnels and one transfibular tunnel. The semitendinosus tendon acts as a soft tissue sling and does not interfere with mobility at the proximal or distal tibiofibular joints as noted after fibular head resection or arthrodesis of the proximal tibiofibular joint. Further advantages are the easy accessibility of the semitendinosus graft and the small surgical scar with better cosmetic results as compared to ligamentous reconstructive procedures using a split biceps femoris tendon or a strip of the iliotibial band.