Proximal Tibiofibular Joint Instability and Treatment Approaches: A Systematic Review of the Literature

Abstract

Purpose: To evaluate the treatment options, outcomes, and complications associated with proximal tibiofibular joint (PTFJ) instability, which will aim to improve surgical treatment of PTFJ instability and aid surgeons in their decision making and treatment selection.

Methods: A systematic review was performed according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Inclusion criteria were as follows: PTFJ instability treatment techniques, PTFJ surgical outcomes, English language, and human studies. Exclusion criteria were cadaveric studies, animal studies, basic science articles, editorial articles, review articles, and surveys. Furthermore, we excluded studies that did not report patient follow-up time and studies without any patient-reported, clinical or radiographic outcomes at the final follow-up.

Results: The systematic review identified 44 studies (96 patients) after inclusion and exclusion criteria application. For the treatment of PTFJ instability, there were 18 studies (35 patients) describing nonoperative management, 3 studies (4 patients) reported on open reduction, 11 studies (25 patients) reported on fixation, 4 studies (10 patients) that described proximal fibula resection, 3 studies (11 patients) reported on adjustable cortical button repair, 2 studies (3 patients) reported on ligament reconstructions, and 5 (8 patients) studies reported on biceps femoris tendon rerouting. The most (77% to 90%) PTFJ dislocations and instability were anterolateral/unspecified anterior dislocation or instability. Improved outcomes after all forms of PTFJ instability treatment were reported; however, high complication rates were associated with both PTFJ fixation (28%) and fibular head resection (20%).

Conclusions: Improved outcomes can be expected after surgical treatment of PTFJ instability. Proximal tibiofibular ligament reconstruction, specifically biceps rerouting and anatomic graft reconstruction, leads to improved outcomes with low complication rates. Nonoperative treatment is associated with persistent symptoms, whereas both fixation and fibular head resection are associated with high complication rates.

Level of evidence: Level IV, systematic review of level IV studies.