Purpose
To assess the most common presenting symptoms, clinical outcomes, and satisfaction
after anatomic reconstruction of the proximal tibiofibular joint (PTFJ) with a free
semitendinosus autograft.
Methods
Consecutive patients with minimum 2-year follow-up after isolated anatomic PTFJ reconstruction
were retrospectively reviewed. Patients were evaluated with the Western Ontario and
McMaster Universities Osteoarthritis Index (WOMAC) score and Lysholm Knee Survey score
along with a simple numeric patient satisfaction score (0-10, with 10 rated as perfect).
Statistical analysis was performed with paired t tests, with P < .05 considered significant.
Results
The study included 16 PTFJ reconstruction surgical procedures in 15 patients with
isolated proximal tibiofibular instability verified by an examination under anesthesia
(4 reconstructions in male patients vs 12 in female patients); the average age was
37.9 ± 14.6 years, with an average follow-up period of 43.2 months (range, 22-72 months).
Of the 13 patients with complete follow-up, 11 (84.6%) were able to return to full
desired activities and previous level of sport. Fourteen patients presented with concomitant
common peroneal nerve pathology. Two patients had a subsequent complication. No patients
needed an additional procedure. Significant (P < .05) improvement occurred across all WOMAC domains and in the WOMAC total score,
from 31.4 (±14.9) preoperatively to 15.2 (±15.5) postoperatively. Lysholm Knee Survey
scores significantly (P < .05) improved from 51.2 (±17.2) to 75.0 (±18.0). Patients’ overall satisfaction
was rated 7.6 (± 2.7) of 10.
Conclusions
At an average follow-up of 43.2 months, anatomic PTFJ reconstruction for isolated
PTFJ instability provided improvement in clinical outcomes, a return to activities,
and a low risk of complications or need for additional procedures.
Clinical Relevance
PTFJ reconstruction with hamstring tendon graft is a promising surgical treatment
that improves patient satisfaction when conservative treatment of PTFJ instability
fails.
Level of Evidence
Level IV, case series.
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Article info
Publication history
Published online: February 13, 2020
Accepted:
January 31,
2020
Received:
September 12,
2019
Footnotes
The authors report the following potential conflicts of interest or sources of funding: R.F.L. receives royalties from Arthrex and Smith & Nephew; is a paid consultant for Arthrex, Ossur, and Smith & Nephew; receives research support from Arthrex, Linvatec, Ossur, and Smith & Nephew; is on the editorial or governing board of the American Journal of Sports Medicine and Knee Surgery, Sports Traumatology, Arthroscopy; and has member or committee appointments for American Orthopaedic Society for Sports Medicine, International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine, and Arthroscopy Association of North America. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2020 by the Arthroscopy Association of North America
