Abstract
Purpose
Proximal tibiofibular joint (PTFJ) dislocations are under-investigated injuries. There is scant basic science or clinical evidence to direct management. The purpose of this study was twofold; first to investigate the pathomechanics of PTFJ dislocation on knee mechanics. The second purpose was to evaluate knee mechanics following reduction and fixation.
Methods
Six cadaveric legs were tested on a mechanical platform. A 5 Nm external rotation force was applied to each knee and the external rotation and fibular translation was measured for several study conditions at 0°, 30°, and 90° of flexion. Conditions included: the native state, transection of the posterior PTFJ ligament, transection of the anterior and posterior ligaments, screw fixation, and suspensory fixation. Screw fixation was performed using a single quadricortical 3.5 mm screw. Suspensory fixation was performed using an Arthrex TightRope device
Results
Transection of the anterior and posterior ligaments increased external rotation by 4.3°, 5.9°, and 5.6°, at 0°, 30°, and 90° (p ≤ 0.001), respectively. Screw and suspensory fixation returned external rotation to a near native state with mild overconstraint. Complete transection of anterior and posterior ligaments resulted in pathologic anterior fibular translation of 1.51 mm (p = 0.001), 1 mm, (p = 0.02) and 0.44 mm (p = 0.69) for 0°, 30°, 90° of knee flexion. Screw and suspensory fixation restored native translation at all points with a small degree of overconstraint.
Conclusion
Disruption of the PTFJ causes pathologic external rotation and anterior fibular translation. Fixation restores near native motion with minor overconstraint. Surgeons should consider reduction and fixation of PTFJ injuries to restore native knee mechanics.
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EAM involved in study design, data collection, data analysis, and manuscript preparation. ST participated in study design, data collection, statistical preparation, and manuscript editing. KP involved in data collection. MH participated in study design and editing. MG participated in study design and manuscript editing. RF involved in study design, data analysis, and manuscript editing.
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Magnusson, E.A., Telfer, S., Parker, K. et al. The effect of proximal tibiofibular joint dislocation on knee mechanics: reduction and fixation matters. Eur J Orthop Surg Traumatol 32, 821–826 (2022). https://doi.org/10.1007/s00590-021-03047-4
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DOI: https://doi.org/10.1007/s00590-021-03047-4