Repair with bicortical suspension device restores proximal tibiofibular joint motion
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Dislocation of the proximal tibiofibular joint is a complex injury that is often overlooked or misdiagnosed. Surgical treatment is recommended for severe acute or for chronic symptomatic instability but there is still no evidence on the optimal reconstruction technique. The purpose of this study is to analyze the motion of the proximal tibiofibular joint after repair with a bicortical suspension device as compared to its normal kinematics.
Kinematic analysis of the proximal tibiofibular joint was performed during continuous passive motion of the knee and ankle in 7 whole body cadavers in a controlled laboratory study. The 14 knees were measured in four conditions: (1) intact; (2) repair with transarticular bicortical suspension device tensioned to 40 N; (3) the same repair tensioned to 50 N; and (4) the repair tensioned to 50 N after interosseous syndesmotic membrane sectioning.
Proximal tibiofibular joint can be successfully repaired by a bicortical suspension device restoring its normal 3D spatial motion. The fixation of the PTFJ with the device tested tensioned to 40 or 50 N could restore the intact joint kinematics for every movement tested except knee internal and external rotation. The fixation to 40 N attained closer values to the intact joint in the movements that evolve the anterior PTFJ ligament. The 50 N fixation is overall more rigid than the intact joint but statistically closer to the normal PTFJ kinematics for the movements more dependent on the posterior PTFJ ligament. Sectioning of the interosseous syndesmotic membrane determined an important loss of stability of the PTFJ during the movements of ankle extension and ankle flexion. Such loss illustrates the relevance of this associated injury when planning PTFJ ligament reconstruction.
This study indicates that the repair of the proximal tibiofibular joint with a transarticular bicortical suspension device tensioned to 40 and 50 N can restore the normal kinematics of this joint. Based on these findings, Surgeons may consider this option as a reliable solution when planning successful treatment for proximal tibiofemoral joint instability.
KeywordsProximal tibiofibular joint Tibiofibular instability Bicortical suspension device Kinematics Knee
- CT scan
Computed tomography scan
Magnetic resonance imaging
Proximal tibiofibular joint
Interosseous syndesmotic membrane
We thank Professor João Gory O´Neil and the Department of Anatomy of Medical College, Universidade Nova de Lisboa for provision of the specimens and assistance with laboratory setup. We thank Professor Ricardo Matias, Physiotherapist Mario Valerio and PhD Candidate Rodrigo Brandão Martins who contributed towards the article by making acquisition and analysis of data. We thank Instituto Politécnico de Setúbal for providing the kinematic analysis instruments. We thank Biomet, and Arthrex for providing the medical devices.
PP, TAS and FGP conceived the study, participated in its design and coordination, carried out the experimental study, participated in the sequence alignment and drafted the manuscript. All authors read and approved the final manuscript. PP is the Senior Orthopaedic Surgeon of the Medical Department of a professional soccer team—Sporting Clube de Portugal. TAS and FGP are Orthopaedic Surgeons.
No funding was received for this study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests with respect to the research, authorship and publication of this article. The authors received no financial support for the research, authorship and publication of this article.
Ethical approval was not required for this study.
Informed consent was not applicable to this study.
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