Proximal Tibiofibular Joint Instability: Outcomes After Combined Tibiofibular Joint and Lateral Collateral Ligament...

Proximal tibiofibular joint (PTFJ) instability is a relatively rare clinical condition, and the establishment of an evidence-based standard of care remains an ongoing challenge because of its low incidence in the literature. Current reports in the literature focus on isolated PTFJ reconstruction, and there remains to be any report on outcomes of PTFJ reconstruction performed concurrently with procedures for associated knee injuries, such as lateral collateral ligament (LCL) insufficiency coupled with tibiofibular instability.

To assess subjective and clinical outcomes after combined reconstruction of the LCL and PTFJ utilizing a semitendinosus allograft in the setting of anterior PTFJ instability and concomitant knee injuries requiring additional procedures.

Case series; Level of evidence, 4.

A retrospective review was conducted on consecutive patients who underwent anatomic PTFJ reconstruction utilizing a semitendinosus allograft from 2016 to 2021, with a ≥2-year follow-up. Exclusion criteria included ipsilateral concomitant lower extremity fracture, prior knee surgery, previous diagnosis of connective tissue disorder, and postoperative follow-up <2 years. Clinical outcomes were measured by PROs (return to function, return to play, International Knee Documentation Committee [IKDC], Single Assessment Numeric Evaluation score, Lysholm score, 12-item Short Form Health Survey, and range of motion), radiographic parameters, and subjective outcome measures obtained through a retrospective chart review, as well as a patient outcomes questionnaire.

Between August 2016 and November 2021, 29 patients underwent combined PTFJ and LCL reconstruction by the senior author. Of these, 25 patients (86%) met inclusion criteria and had a mean follow-up of 4.3 ± 2.1 years. Concomitant procedures were performed in 20 patients (80%), including anterior cruciate ligament reconstruction (48%), PCL reconstruction or repair (12%), and meniscal procedures (52%). Significant improvements were observed in patient-reported outcome measures, including the Lysholm score (preoperatively: median, 49 [IQR, 30-56]; follow-up: median, 95 [IQR, 76-95]; P < .001), IKDC (preoperatively: median, 34 [IQR, 18-54]; follow-up: median, 83 [IQR, 72-95]; P < .001), and Western Ontario and McMaster Universities Osteoarthritis Index total score (preoperatively: median, 36 [IQR, 21-49]; follow-up: median, 2 [IQR, 0-7]; P < .001). No patients required revision surgery related to the combined reconstruction. Sporting activity level remained high at follow-up (Tegner Activity Scale: median, 6.0 [IQR, 3.0-7.0]).

Favorable outcomes can be expected after combined LCL and PTFJ reconstruction utilizing a semitendinosus allograft, even when performed alongside other procedures for concomitant injuries.