Dual adjustable stabilization of proximal tibiofibular joint (PTFJ) instability using suspensory fixation and a split biceps femoris autograft
Rald V.M. Groven, Maria Gabriella Fois, Max Praster, Frank Hildebrand, Carl-Wilhelm Borgs, Klemens Horst, Christian D. WeberAbstract
Objectives
To describe a novel dual adjustable stabilization technique for symptomatic anterolateral instability of the proximal tibiofibular joint (PTFJ) in a young athlete after failed conservative treatment.
Case presentation
A 15-year-old female soccer player presented with persistent lateral knee pain and snapping following trauma. Clinical examination and magnetic resonance imaging confirmed anterolateral PTFJ instability with injury to the posterior ligamentous structures. Reconstruction combined biological augmentation using a split biceps femoris tendon autograft with preserved distal insertion and mechanical stabilization using two adjustable suspensory fixation devices. The graft was passed through a tibial tunnel along the anatomical course of the posterior tibiofibular ligaments, with additional transfibular-transtibial stabilization. Postoperative imaging confirmed anatomical reduction of the fibular head and correct implant positioning. At follow-up (2 and 6 weeks, 3 and 6 months), the patient showed rapid clinical improvement, with marked pain reduction, complete resolution of snapping, restored joint stability, and no neurological deficits.
Conclusions
Dual adjustable stabilization combines mechanical stabilization with biological reconstruction and may be a promising treatment option for symptomatic PTFJ instability refractory to conservative management. Further studies are needed to evaluate long-term outcomes.