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Knapik DM, Gopinatth V, Jackson GR, LaPrade RF, Chahla J, Brophy RH, Matava MJ, Smith MV. Isolated, Proximal Tibiofibular Injuries in Athletic Patients: A Critical Analysis Review. J Knee Surg 2024. [PMID: 38677295 DOI: 10.1055/a-2315-7691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
While infrequently reported, isolated injuries to the proximal tibiofibular (TF) joint primarily occur in young, athletic patients participating in sporting activities requiring explosive, high-impact movements, increasing the risk for potential twisting injuries, especially across a hyperflexed knee. The proximal TF joint is stabilized by bony, muscular and ligamentous structures, including both the anterior and posterior proximal TF complexes, with the anterior complex providing more robust stability. Proximal TF injuries frequently involve anterior and lateral displacement of the proximal fibula relative to its native articulation with the tibia. Proper diagnosis is dependent on careful and meticulous history and physical examination, as missed injuries are common, leading to the potential for continued pain, weakness and disability, especially in athletic patients. While spontaneous joint reduction has been reported, injuries may require formal closed reduction, with irreducible and chronic injuries requiring open reduction and stabilization, with recent investigations reporting satisfactory outcomes following anatomic reconstruction of the proximal TF ligament.
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Affiliation(s)
- Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Varun Gopinatth
- St. Louis University School of Medicine, St. Louis, Missouri
| | - Garrett R Jackson
- Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush University, Chicago, Illinois
| | | | - Jorge Chahla
- Department of Orthopaedic Surgery, Midwest Orthopaedics at Rush University, Chicago, Illinois
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Matthew J Matava
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Matthew V Smith
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri
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Shao B, Xing J, Zhao B, Wang T, Mu W. Role of the proximal tibiofibular joint on the biomechanics of the knee joint: A three-dimensional finite element analysis. Injury 2022; 53:2446-2453. [PMID: 35610073 DOI: 10.1016/j.injury.2022.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/21/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The proximal tibiofibular joint (PTFJ) is easily ignored, although many diseases of the knee are caused by PTFJ injuries. Therefore, studying PTFJ biomechanics is very important. The effects of PTFJ injury on ankle function have been reported. However, few studies have assessed the effects of PTFJ injury on the knee joint. This study was performed to describe the biomechanical effects of PTFJ on the knee joint according to a three-dimensional finite element model. METHODS The knee joint of a healthy volunteer was scanned by CT and MRI. CT and MRI scanning data in DICOM format were imported into Mimics software. Subsequently, 3D models of the normal and PTFJ injured knee, including the bone, cartilage, meniscus and ligament structures were established, and their validity was verified on the basis of available studies in literature. The biomechanical changes in the two knee models under different conditions were compared. RESULTS The validity of the intact model was verified. No significant difference was observed in tibial mobility in the two models under the conditions of 134 N forward, 10 N·m internal rotation and 10 N·m valgus load. After application of 134 N backward, 10 N·m varus and external rotation load with respect to the tibia, the posterior movement of the tibia and the varus and external rotation angles of the tibia were 3.583±0.892 mm, 4.799±0.092° and 18.963±0.027° in the normal knee model, and 5.127±1.224 mm, 5.277±0.104° and 21.399±0.031° in the PTFJ injury model, respectively, and a significant statistical difference was observed. CONCLUSIONS PTFJ played an important role in maintaining the posterolateral stability of the knee joint and thus deserves more attention in clinical operations.
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Affiliation(s)
- Bin Shao
- Department of Traumatic Orthopaedics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Department of Orthopaedics, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Jianqiang Xing
- Department of Orthopaedics, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Bei Zhao
- Department of Orthopaedics, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Tingguang Wang
- Department of Orthopaedics, The People's Hospital of Zouping City, Zouping, Shandong, China
| | - Weidong Mu
- Department of Traumatic Orthopaedics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
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Traumatic Dislocation of the Proximal Tibiofibular Joint: A Systematic Review and 10-year Experience From a Level 1 Trauma Center. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202205000-00001. [PMID: 35503776 PMCID: PMC9076448 DOI: 10.5435/jaaosglobal-d-21-00105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 03/15/2022] [Indexed: 11/18/2022]
Abstract
Introduction: Methods: Results: Discussion:
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Camille C, Olivier B. Proximal tibiofibular stabilization by anatomical ligamentoplasty and diaphyseal osteotomy of the fibula. Chin J Traumatol 2022; 25:177-180. [PMID: 34034948 PMCID: PMC9125725 DOI: 10.1016/j.cjtee.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/10/2021] [Accepted: 04/18/2021] [Indexed: 02/04/2023] Open
Abstract
Proximal tibiofibular instability is a rare condition for which treatment is poorly codified. A 21-year-old patient, a leisure sportswoman, presented a post-traumatic anterolateral instability of the proximal tibiofibular articulation without cartilage lesion. We propose an original surgical technique based on a review of the literature that combines an anatomical ligamentoplasty of the proximal tibiofibular joint and a proximal fibular diaphyseal osteotomy to reduce the distal tibiofibular mechanical stresses. This original technique allows a favorable evolution with recovery of professional and sports activities at 6 months.
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Affiliation(s)
- Choufani Camille
- Clinic of Orthopedics and Traumatology, Military Teaching Hospital Sainte-Anne, 2 Boulevard Sainte-Anne, 83000, Toulon, France,Toulon Mediterranean Orthopedic and Sport Trauma, 83000, Toulon, France,Corresponding author. Clinic of Orthopedics and Traumatology, Military Teaching Hospital Sainte-Anne, 2 Boulevard Sainte-Anne, 83000, Toulon, France.
| | - Barbier Olivier
- Clinic of Orthopedics and Traumatology, Military Teaching Hospital Sainte-Anne, 2 Boulevard Sainte-Anne, 83000, Toulon, France,Toulon Mediterranean Orthopedic and Sport Trauma, 83000, Toulon, France
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Sacchetti A, Verbaro J. Proximal tibiofibular joint dislocation in young children: Is this the nursemaid's elbow of the lower extremity? Am J Emerg Med 2021; 54:328.e3-328.e4. [PMID: 34774384 DOI: 10.1016/j.ajem.2021.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022] Open
Abstract
Anterolateral dislocation of the Proximal Tibiofibular Joint (PTFJ) is a rare injury of the knee commonly resulting from violent athletic injuries in adults. Reported here are examples of this injury in a 19 month old and a 4 year old following trivial mechanisms of injury. These cases raise the question of whether this injury may be an unrecognized cause of refusal to bear weight in children in this age group.
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Affiliation(s)
- Alfred Sacchetti
- Department of Emergency Medicine, Virtua Our Lady of Lourdes Hospital, 1600 Haddon Ave., Camden, NJ O8103, United States of America.
| | - Jackie Verbaro
- Department of Emergency Medicine, Virtua Our Lady of Lourdes Hospital, 1600 Haddon Ave., Camden, NJ O8103, United States of America
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Oki S, Kobayashi H, Kubota H, Umezu T, Nagasaki M, Iwabu S. A Pilon Fracture With Fibular Head Dislocation Treated With the Use of 3D Preoperative Planning: A Case Report and Literature Review. J Foot Ankle Surg 2021; 60:404-407. [PMID: 33423890 DOI: 10.1053/j.jfas.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/10/2020] [Accepted: 09/29/2020] [Indexed: 02/03/2023]
Abstract
Pilon fractures with intact fibula have been associated with low-energy trauma. However, the compression force onto the ankle joint can damage the tibiofibular linkage as in a Maisonneuve fracture. Herein, we describe a case of a patient who had a pilon fracture (AO type 43 C3.2) without a fibular fracture. Three-dimensional preoperative simulation by reduction with the surface registration technique was performed as the fibular length was intact and there was no reference for the tibial length. The preoperative simulation revealed superior fibular head dislocation and shortening of the distal tibia. After emergency external fixation on the day of arrival, a 2-staged surgery was performed. During the first operation, the fibular head was reduced and the tibial posterolateral fragment was fixed to restore the tibia length. During the second operation, medial and anterolateral fragments were fixed in order to reduce joint surface of the distal tibia. In general, proximal fibular head fractures are easily overlooked. In the case of pilon fractures with severe length shortening of the tibia without a fibular fracture, a proximal tibiofibular injury should be suspected.
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Affiliation(s)
- Satoshi Oki
- Orthopedic Surgeon, Department of Orthopedic Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan; Orthopedic Surgeon, Department of Clinical Biomechanics, Keio University School of Medicine, Tokyo Japan.
| | - Hiroki Kobayashi
- Orthopedic Surgeon, Department of Orthopedic Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Hidejiro Kubota
- Orthopedic Surgeon, Department of Orthopedic Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Taro Umezu
- Orthopedic Surgeon, Department of Orthopedic Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Minoru Nagasaki
- Physical Therapist, Department of Rehabilitation Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Shohei Iwabu
- Orthopedic Surgeon, Department of Orthopedic Surgery, Saiseikai Utsunomiya Hospital, Tochigi, Japan
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