We present a case report of proximal tibiofibular joint instability treated with a dynamic syndesmosis fixation device. A dynamic fixation device allows for micro-motion at the proximal tibiofibular joint. With some limited motion at the proximal tibiofibular joint, the fibula is able to migrate inferiorly and increase ankle stability. This has a distinct advantage over traditional fixation techniques, such as arthrodesis, which do not allow motion and may contribute to long-term ankle injuries. Background Proximal tibiofibular subluxation is an uncommon injury that results in moderate instability and discomfort about the knee joint. Isolated injury to the joint is often the result of a wide variety of traumatic sports related injuries including violent twisting or a direct blow.1 Due to stability afforded by the LCL, dislocation of the proximal tibiofibular joint requires the knee to be in a flexed position.1 Most injuries result in the inability to pivot and plant the affected side at the ankle with day to day instability. Associated injuries are rare, however, the peroneal nerve can be injured. Traditionally there are four patterns of injury to the proximal tibiofibular joint, three classifications of dislocations including anterolateral, posteromedial and superior (anterolateral being the most common) and one of subluxation that is often the result of chronic instability.3 Injury occurs most commonly in the second to fourth decades of life. Historically a little over half of patients with acute dislocations require surgical correction for recurring symptoms. The major concern with surgical fixation is the development of osteoarthritis in the ipsilateral ankle joint due to decreased motion. This article presents a case in which dynamic (TightRopeTM, Arthrex, Naples, Florida) fixation was used to stabilize the proximal tibiofibular joint. 2 Case Report A 48 year-old female presents with a history of left proximal tibiofibular joint instability and three episodes of posterior dislocation of the fibular head causing her knee to lock in a flexed position. Her latest episode spontaneously reduced with mild manipulation. Prior MRI examination of the left knee revealed no apparent reason for dislocation. The patient history is also positive for degenerative joint disease in her knees bilaterally. Physical examination of the left knee revealed mild soft tissue swelling along the proximal tibiofibular articulation. Range of motion, strength and stability were all normal. The patient was tender to palpation along the fibular head as well as the proximal tibiofibular articulation. The fibular head demonstrated marked increase in motion with an anterior and posterior drawer in relationship to the tibiofibular articulation. Due to the history of recurrent symptoms the patient underwent surgery.
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