Anatomic Reconstruction of the Proximal Tibiofibular Joint

Proximal tibiofibular joint (PTFJ) instability can be easily missed or confused for other, more common lateral knee pathologies such as meniscal tears, fibular collateral ligament injury, biceps femoris pathology, or iliotibial band syndrome. Because of this confusion, some authors believe that PTFJ instability is more common than initially appreciated. Patients with PTFJ subluxation may have no history of inciting trauma or injury, and it is not uncommon for these patients to have bilateral symptoms and generalized ligamentous laxity. Currently, the optimal surgical treatment for patients with chronic PTFJ instability is unknown. Historically, a variety of surgical treatments have been reported. Initially, joint arthrodesis and fibular head resection were recommended. More recently, temporary screw fixation, nonanatomic reconstruction with strips of the biceps femoris tendon or iliotibial band, and reconstruction with free hamstring autograft have been described. The purpose of this report is to present our surgical technique for treatment of chronic PTFJ instability using an anatomic reconstruction of the posterior ligamentous structures of the PTFJ with a semitendinosus autograft.