Associated Reconstruction Of Acl And Lcl Tears Plus Proximal Tibiofibular Joint Instability With Asymmetric Hamstring Graft.

BACKGROUND

Proximal tibiofibular joint (PTFJ) dislocation is a rare injury, and if missed or misdiagnosed, it can lead to chronic PTFJ instability, especially in the case of a multiligamentous knee injury. Optimal treatment is poorly understood and includes a vast arsenal of surgical techniques.

INDICATIONS: Surgical treatment is indicated in cases of PTFJ dislocations that are irreducible by closed means, chronic symptomatic dislocations/instability, and first-time dislocations with bony fracture. Risk of persistent symptoms has been reported to be higher than acceptable with conservative management. Anatomical reconstruction is necessary to restore the optimal PTFJ biomechanics and to improve clinical outcomes. The case of a patient with an uncommon set of multiligamentous knee injuries, that is, PTFJ dislocation, anterior cruciate ligament (ACL), and lateral collateral ligament (LCL) tear, is presented, along with a surgical approach not previously described in the literature.

STUDY

DESIGN

Case report and a surgical technique; Level of evidence, 4.

TECHNIQUE DESCRIPTION: A surgical technique is described for the combined reconstruction of ACL, LCL, and PTFJ injuries using asymmetrically prepared hamstring autografts. The procedure includes an extra-articular lateral reinforcement through a modified Lemaire procedure, utilizing a single femoral tunnel. Fixation is achieved with a tibial suspension device for ACL reconstruction, a shared femoral fixation for both the ACL and LCL grafts, and a combined tibial fixation for the LCL and PTFJ reconstruction.

RESULTS

The present technique provides a suitable option for the rare combined injury involving ACL and LCL tears along with PTFJ disruption, using a single hamstring graft, a modified Lemaire procedure, and only 3 fixation points for the reconstruction.

DISCUSSION/

CONCLUSION

The reconstruction of multiligament knee injuries often requires multiple grafts-including allografts-along with a high risk of tunnel convergence and loss of bone stock. The present technique offers a safe and feasible alternative that preserves bone stock and avoids the need for allografts.

PATIENT CONSENT DISCLOSURE STATEMENT: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.