Proximal Tibiofibular Reconstruction in Adolescent Patients

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Presentation transcript:

Proximal Tibiofibular Reconstruction in Adolescent Patients Mitchell I. Kennedy, B.S., Nicholas N. Dephillipo, M.S., A.T.C., O.T.C., Gilbert Moatshe, M.D., Ph.D., Patrick S. Buckley, M.D., Andrew S. Bernhardson, M.D., Robert F. LaPrade, M.D., Ph.D.  Arthroscopy Techniques  Volume 7, Issue 12, Pages e1305-e1310 (December 2018) DOI: 10.1016/j.eats.2018.08.017 Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 1 External view of the opening lateral hockey stick incision over the inferior aspect of the superficial layer of the iliotibial band prior to dissection through the superficial layer down to the long and short head of the biceps femoris (right knee). Arthroscopy Techniques 2018 7, e1305-e1310DOI: (10.1016/j.eats.2018.08.017) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 2 External view of CPN (right knee), after a 6-cm-long CPN neurolysis in which release of all scar tissue surrounding the nerve is performed, in addition to releasing the lateral fascia of the peroneus longus muscle. (CPN, common peroneal nerve.) Arthroscopy Techniques 2018 7, e1305-e1310DOI: (10.1016/j.eats.2018.08.017) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 3 External view of the identification of the anterior aspect of the fibular head (right knee) which is followed by dissection down to bone and subsequent decortication, prior to guide pin placement and fibular tunnel reaming. Arthroscopy Techniques 2018 7, e1305-e1310DOI: (10.1016/j.eats.2018.08.017) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 4 Fluoroscopic imaging of a right knee in (A) anteroposterior (AP) and (B) lateral views, displaying guide pin placement below the open physis of an adolescent knee so as to not damage the growth plate and potentially disturb/alter bone growth of the fibula. Pin placement on an adolescent fibula should be placed 5 to 6 mm distal to the fibular “physis line.” Arthroscopy Techniques 2018 7, e1305-e1310DOI: (10.1016/j.eats.2018.08.017) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 5 External view of the identification of the flat spot distal and medial to the Gerdy tubercle on a right knee, which is followed by dissection down to bone and subsequent decortication, before guide pin placement and tibial tunnel reaming. Arthroscopy Techniques 2018 7, e1305-e1310DOI: (10.1016/j.eats.2018.08.017) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 6 Fluoroscopic imaging of a right knee in (A) anteroposterior (AP) and (B) lateral views, displaying guide pin placement below the open physis of the tibia on an adolescent knee to avoid damage to the physis and potential disturbance/alteration of tibia bone growth. Pin placement on an adolescent tibia should be placed >5 to 6 mm distal to the tibial “physis line.” Arthroscopy Techniques 2018 7, e1305-e1310DOI: (10.1016/j.eats.2018.08.017) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions

Fig 7 External view of graft passage in a right knee. The graft is first passed anterior to posterior through the fibular head tunnel (A) and is fixed with a 7×23-mm bioabsorbable screw (B). While reducing the PTFJ to the knee joint with the knee flexed to 70° and the foot in neutral rotation, the graft is passed from posterior to anterior through the tibial tunnel (C), and the graft is fixed in the tibial tunnel with a 7×23-mm bioabsorbable screw (D). Arthroscopy Techniques 2018 7, e1305-e1310DOI: (10.1016/j.eats.2018.08.017) Copyright © 2018 Arthroscopy Association of North America Terms and Conditions