Isolated Proximal Tibiofibular Joint Reconstruction With Semitendinosus Tendon Autograft in a Collegiate Athlete

Proximal tibiofibular joint (PTFJ) instability is a rare and often underrecognized cause of lateral knee pain and dysfunction, most commonly presenting as anterolateral subluxation of the fibular head after trauma. While conservative management is first-line, persistent instability may require operative intervention.

We present the case of a 20-year-old male athlete who sustained a PTFJ injury during sport and noted instability. After a successful PTFJ diagnostic taping trial, he elected for surgical reconstruction after completing his competitive season. Imaging confirmed an isolated PTFJ pathology without intra-articular knee injury.

The reconstruction was performed using an ipsilateral semitendinosus tendon autograft. After a standard semitendinosus tendon harvest, a posterolateral approach to the fibular head was performed. A common peroneal nerve neurolysis was performed. The fibular head and proximal lateral tibial tunnels were reamed to reproduce the anatomic attachments of the native ligaments. The graft was passed from anterior to posterior through the fibular tunnel and secured with a bioabsorbable screw. The remaining graft was then passed from posterior to anterior through the tibia and secured using a bioabsorbable interference screw at 70° of knee flexion.

Isolated anatomic reconstruction of the PTFJ using a semitendinosus tendon autograft provides excellent restoration of joint stability in cases of chronic anterolateral instability. Postoperative assessment consistently demonstrates elimination of symptomatic subluxation and restoration of fibular head stability under clinical examination. These outcomes align with findings in the limited published literature, which report high rates of return to activity and symptom resolution after anatomic PTFJ reconstruction using autograft techniques.

Anatomic reconstruction of the PTFJ using a semitendinosus tendon autograft provides a reproducible, biomechanically sound option for stabilizing the joint, avoiding complications associated with fibular head resection or fixation constructs. This case highlights key technical considerations, such as graft tensioning, tunnel positioning, and peroneal nerve protection, which are all essential for successful outcomes in young athletic patients.

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.