Anatomic reconstruction of chronic symptomatic anterolateral proximal tibiofibular joint instability : Reply to the comments by Michel van den Bekerom.
Director Steadman Philippon Research Institute Biomechanics Research Laboratory, Vail Colorado Complex Knee Surgeon, The Steadman Clinic, Vail Colorado, 181 W. Meadow Drive, Suite 400, Vail, CO, 81657, USA, .Knee Surgery Sports Traumatology Arthroscopy (Impact Factor: 2.68). 04/2011; DOI:10.1007/s00167-011-1494-0
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ABSTRACT: Recurrent dislocations of the superior tibiofibular joint are rare. The majority of these patients are physically active, young adults. Different surgical techniques have been described for the management of this pathology: resection of the proximal aspect of the fibula, arthrodesis of the superior tibiofibular joint with or without fibular osteotomy. Because of the problems reported with these techniques, we opted for Weinert and Giachino ligament reconstruction. From 1989 to 1994, three patients were treated and reviewed in our practice: all, soccer players on the local team, 20, 23, and 25 years old, with superior tibiofibular pain and tumefaction, without neurological symptoms, but with anteroposterior mobility of the fibular head. The average duration of the symptoms before operation was 9 months, and the average follow-up was 15 months. At the follow-up, pain and anteroposterior mobility were gone. Soccer playing was resumed at 7 months without recurrence but with low frequency and stress. In our opinion, the Weinert and Giachino ligament reconstruction, using a portion of the biceps tendon to reconstruct the superior tibiofibular ligament, appears an effective approach to restore indolence and stability to the superior tibiofibular joint and to avoid complications of resection and arthrodesis.Knee Surgery Sports Traumatology Arthroscopy 02/1997; 5(1):36-7. · 2.68 Impact Factor
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ABSTRACT: Thirty cadaveric knees were dissected to obtain a detailed understanding of the anatomic structures of the posterolateral aspect of the knee, and a dependable surgical approach to evaluate injuries to these structures was developed and used on 71 consecutive patients who were operated on for posterolateral knee injuries. Three fascial incisions and one lateral midcapsular incision were used to provide surgical access. The following individual anatomic structures were identified: the layers of the iliotibial tract, long and short heads of the biceps femoris muscle, fibular collateral ligament, midthird lateral capsular ligament, fabello-fibular ligament, posterior arcuate ligament, popliteus muscle complex, lateral coronary ligament, and posterior capsule. This study increased our understanding of the individual anatomic structures and the relationships between these components. The surgical approach provided for the evaluation of these anatomic structures should aid the surgeon in properly assessing the injuries before surgical repair. This information should also stimulate more anatomic, biomechanical, and clinical studies of the posterolateral aspect of the knee.The American Journal of Sports Medicine 01/1996; 24(6):732-9. · 4.44 Impact Factor
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