To the editor,
Thank you for your insightful questions.
One of the goals of our paper was to bring recognition to a possible associated injury in the setting of a multiligament injured knee. As previously mentioned, the frequency of proximal tibiofibular joint instability in this group of patients is truly unknown, and associated injuries in our cohort of patients, including fractures, also were common. There have been numerous techniques described [2–5] to surgically stabilize an unstable proximal tibiofibular joint as mentioned in our paper. We do not necessarily believe that our technique is better than any other, and certainly further studies may help answer the question of what technique offers the best clinical results.
The decision to use screw fixation to stabilize the proximal tibiofibular joint in our group of patients was made partly due to the availability of the hardware. On many occasions, the diagnosis was not made until the time of surgery. Moreover, similar techniques have been used to stabilize the distal tibiofibular joint with good results [1, 6, 7]. To date, we have not experienced any known screw breakage, and have removed the screw in two patients due to local pain around the screw. Both patients have not experienced any further issues.
Footnotes
(RE: Jabara M, Bradley J, Merrick M. Is Stability of the Proximal Tibiofibular Joint Important in the Multiligament-injured Knee? [Published online ahead of print March 25, 2014]. Clin Orthop Rel Res. DOI:10.1007/s11999-014-3574-1.)
Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.
The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR ® or the Association of Bone and Joint Surgeons®.
References
- 1.Høiness P, Strømsøe K. Tricortical versus quadricortical syndesmosis fixation in ankle fractures: a prospective, randomized study comparing two methods of syndesmosis fixation. J Orthop Trauma. 2004;18:331–337. doi: 10.1097/00005131-200407000-00001. [DOI] [PubMed] [Google Scholar]
- 2.Horst P, LaPrade R. Anatomic reconstruction of chronic symptomatic anterolateral proximal tibiofibular joint instability. Knee Surg Sports Traumatol Arthrosc. 2010;18:1452–1455. doi: 10.1007/s00167-010-1049-9. [DOI] [PubMed] [Google Scholar]
- 3.Luscombe KL, Maffulli N. Stabilization of the superior tibiofibular joint. Tech Knee Surg. 2005;4:126–130. doi: 10.1097/01.btk.0000164754.96904.a3. [DOI] [Google Scholar]
- 4.Maffulli N, Spiezia F, Oliva F, Testa V, Capasso G, Denaro V. Gracilis autograft for recurrent posttraumatic instability of the superior tibiofibular joint. Am J Sports Med. 2010;38:2294–2298. doi: 10.1177/0363546510373472. [DOI] [PubMed] [Google Scholar]
- 5.Miettinen J, Kettunen J, Vaatainen U. Dislocation of the proximal tibiofibular joint: a new method of fixation. Arch Orthop Trauma Surg. 1999;119:358–359. doi: 10.1007/s004020050428. [DOI] [PubMed] [Google Scholar]
- 6.Moore JA, Jr, Shank JR, Morgan SJ, Smith WR. Syndesmosis fixation: a comparison of three and four cortices of screw fixation without hardware removal. Foot Ankle Int. 2006;27:567–572. doi: 10.1177/107110070602700801. [DOI] [PubMed] [Google Scholar]
- 7.Wikerøy AKB, Høiness PR, Andreassen GS, Hellund JC, Madsen JE. No difference in functional and radiographic results 8.4 years after quadricortical compared with tricortical syndesmosis fixation in ankle fractures. J Orthop Trauma. 2010;24:17–23. doi: 10.1097/BOT.0b013e3181bedca1. [DOI] [PubMed] [Google Scholar]