Proximal Fibula Resection for Tumors-Case Series and Technical Note

Area of Science:

• Orthopedic Surgery
• Musculoskeletal Oncology
• Reconstructive Surgery

Background:

• Tumor resection of the proximal fibula necessitates removal of the lateral collateral ligament (LCL) and biceps femoris tendon (BFT) attachments.
• This anatomical disruption can lead to knee joint instability and functional deficits.

Purpose of the Study:

• To describe and evaluate a surgical reconstruction technique for the LCL and BFT attachments after proximal fibula resection.
• To assess the functional outcomes and knee joint stability following this reconstructive procedure.

Main Methods:

• Six patients undergoing proximal fibula resection were analyzed.
• Reconstruction involved using two suture anchors fixed to the tibia at the proximal tibiofibular joint (PTFJ) to reattach the LCL and BFT.
• Postoperative knee flexion strength and lateral stability were compared to the contralateral limb using digital scales and stress X-rays.

Main Results:

• No significant lateral knee instability or loss of knee flexion strength was observed (p = 0.075).
• One case of persistent postoperative peroneus paresis was reported.
• High functional outcomes were achieved, with a mean Musculoskeletal Tumor Society (MSTS) score of 92.2%.

Conclusions:

• Proximal fibula resection with LCL and BFT reinsertion using bone anchors in the PTFJ provides good functional outcomes.
• The described technique appears to be associated with a low incidence of comorbidities.