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Proximal Tibiofibular Joint: A Forgotten Entity in Multi-Ligament Injuries of the Knee

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Abstract

Purpose

The proximal tibiofibular joint (PTJF) can be injured with the structures in the lateral aspect of the knee in a multi-ligament knee injury (MLKI) patient. Such injuries are scarce but require attention in the management of the complex MLKIs. The assessment and management of such injuries are not well described in the English literature. This study describes the frequency of PTFJ injuries, clinical assessment and functional outcomes of such injuries in MLKI patients.

Methodology

The data were collected retrospectively from the cohort from 2013 to 2018. The 84 MLKI were included in the study, out of which 9 patients had associated PTFJ injury. All the PTFJ injuries were operated by one single surgeon (D.S) which involves stabilization with K-wires (Kirschner wire) and fixation with 4 mm cancellous cannulated screw along with reconstruction surgery for MLKI in single stage.

Results

The frequency of PTFJ injury in our patient cohort is 10.71%. Three patients out of the nine patients received Larson procedure apart from the fixation of PTFJ. At a mean follow-up of 13 months, the Lysholm score was 77.4 (range: 69–86) and mean modified Cincinnati score was 62 (range: 52–72). There was grade I posterior laxity present in one patient with PCL and PLC injury, one patient with ACL, PCL and PLC injury, and one patient with ACL, PCL, MCL and PLC injury at final follow-up. Terminal flexion of 15° or more restriction was noted in six patients. All patients were satisfied with the outcome.

Conclusion

Evaluation of PTFJ should be an integral part of preoperative as well as an intraoperative examination of MLKI patients. The fixation of this joint is of utmost importance for the reconstructive ligament procedures on the lateral aspect of the knee. The dial test used for the assessment of the integrity of PLC injury should have a prerequisite of proximal tibiofibular joint stability, otherwise, it can lead to erroneous assessment.

Level of evidence

IV.

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Authors and Affiliations

  1. Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, Room No 407, Old Resident Doctors Hostel, Maulana Azad Medical College, New Delhi, India

    Dhananjaya Sabat, Rakesh Sehrawat & Bushu Harna

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  1. Dhananjaya Sabat
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  2. Rakesh Sehrawat
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  3. Bushu Harna
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Correspondence to Bushu Harna.

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Informed consent was taken from all the patients included in the study.

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Sabat, D., Sehrawat, R. & Harna, B. Proximal Tibiofibular Joint: A Forgotten Entity in Multi-Ligament Injuries of the Knee. JOIO 55, 425–432 (2021). https://doi.org/10.1007/s43465-020-00296-z

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  • DOI: https://doi.org/10.1007/s43465-020-00296-z

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