title: Gracilis autograft for recurrent posttraumatic instability of the superior tibiofibular joint.
abstract: BACKGROUND
  Several reconstruction procedures have been proposed to manage recurrent dislocation of the superior tibiofibular joint.
  
  
  OBJECTIVE
  Reconstruction of the superior tibiofibular joint using a gracilis tendon autograft is effective in recurrent dislocation of the superior tibiofibular joint.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  Eight patients with recurrent dislocation of the superior tibiofibular joint without anatomical predisposing factors and who practiced sports were included in the study. Evaluation included the modified Cincinnati rating system and the Kujala score, anthropometry, plain radiography, and isokinetic dynamometry.
  
  
  RESULTS
  The average follow-up was 44 ± 13 months. The mean modified Cincinnati score increased from 54 preoperatively to 92 (P = .01). The mean Kujala scores increased from 48 preoperatively to 85 (P = .05). The muscle volume of the thigh of the operated limb remained less well developed than the muscle volume of the nonoperated limb (P = .05). Significant isokinetic strength differences were found between the operated and the contralateral limb (P = .02) even at the latest follow-up.
  
  
  CONCLUSIONS
  Gracilis autograft for posttraumatic instability of the superior tibiofibular joint is a safe, reliable management option for recurrent dislocation of the superior tibiofibular joint in patients without any predisposing factors.
authors.affiliation: Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England. n.maffulli@qmul.ac.uk
authors.forename: Nicola
authors.initials: N
authors.lastname: Maffulli
authors.forename: Filippo
authors.initials: F
authors.lastname: Spiezia
authors.forename: Francesco
authors.initials: F
authors.lastname: Oliva
authors.forename: Vittorino
authors.initials: V
authors.lastname: Testa
authors.forename: Giovanni
authors.initials: G
authors.lastname: Capasso
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Denaro
mesh_terms: D000328:Adult; D001265:Athletic Injuries / Q000601:surgery; D005260:Female; D005360:Fibula / Q000293:injuries; D006305:Health Status Indicators; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D031221:Knee Dislocation / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D007719:Knee Joint; D008297:Male; D009119:Muscle Contraction; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000502:physiology; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D012008:Recurrence; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013710:Tendons / Q000637:transplantation*; D013977:Tibia / Q000293:injuries; D013997:Time Factors; D014182:Transplantation, Autologous / Q000295:instrumentation* / Q000379:methods; D014947:Wounds and Injuries / Q000150:complications; D055815:Young Adult