Surgical Management of Proximal Tibiofibular Joint Instability Using an Adjustable Loop, Cortical Fixation Device

A technique for proximal tibiofibular joint stabilization using an adjustable loop, cortical fixation device is presented. A standard diagnostic arthroscopy is performed to exclude intra-articular pathology. After arthroscopy, a 5-cm posterior-based curvilinear incision is made over the fibular head with dissection of the fascia and decompression of the common peroneal nerve ensuring adequate exposure of the fibular head. A guidewire is placed across 4 cortices using fluoroscopic guidance from the fibular head to the anteromedial tibia. A cannulated drill bit is guided through the 4 cortices. A shuttle wire carrying the adjustable loop, cortical fixation device is fed from lateral to medial and through the skin until the medial cortical button is deployed. The device is tightened until the lateral circular cortical button is secured on the fibula. Fluoroscopy is performed to confirm the button position. The device is secured after tensioning by tying the sutures. To confirm joint stabilization, a shuck test can be performed. If a second fixation device is necessary, this procedure can be repeated distally to the first.