title: Knee stability after resection of the proximal fibula.
abstract: Managing tumors of the proximal fibula may require en bloc resection of the fibular head with the attachment site for the lateral collateral ligament. These resections of the proximal fibula cause unavoidable knee instability. We describe a reconstructive technique intended to minimize that instability. We retrospectively reviewed 24 patients who had proximal fibular resections from 1987 to 2004 and analyzes their knee stability and functional outcome. Resections were less (Type I) or more (Type II) radical depending upon the tumor type. Reconstruction included stapling the lateral collateral ligament to the lateral tibial metaphysis, cast immobilization, and protected weightbearing for 3 weeks. MSTS function scores were available for 19 of the 24 patients. At their most recent followup, 20 patients had a stable knee, three had 1 to 5 mm lateral joint space opening, and one had 6 to 10 mm lateral joint space opening. Patients with Type I resection had a better stability and function than those with a Type II resection. Stapling the lateral collateral ligament was a reliable technique for reconstructing the lateral collateral ligament after resecting the proximal fibula.
authors.affiliation: National Unit of Orthopedic Oncology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. jbickels@012.net.il
authors.forename: Jacob
authors.initials: J
authors.lastname: Bickels
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Kollender
authors.forename: Tamir
authors.initials: T
authors.lastname: Pritsch
authors.forename: Isaac
authors.initials: I
authors.lastname: Meller
authors.forename: Martin M
authors.initials: MM
authors.lastname: Malawer
mesh_terms: D000293:Adolescent; D000328:Adult; D001845:Bone Cysts / Q000628:therapy; D001859:Bone Neoplasms / Q000628:therapy; D017885:Collateral Ligaments / Q000503:physiopathology / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005360:Fibula / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D007719:Knee Joint / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D012509:Sarcoma / Q000628:therapy; D017792:Surgical Stapling / Q000379:methods; D013977:Tibia / Q000601:surgery; D016896:Treatment Outcome