title: Successful Fusion of the Proximal Tibiofibular Joint with Osteogenic Protein-1 (OP-1) Augmentation.
abstract: Proximal tibiofibular joint (PTFJ) instability is rare, but when encountered can be difficult to manage. Previously reported forms of treatment, including cast immobilization, soft tissue repairs and reconstructions, and fibular head resection have met with limited success. Another option is PTFJ arthrodesis-however, fusion can be difficult and ankle pain after surgery is not uncommon. In this report, we present a novel surgical technique used to treat PTFJ instability. It is a form of PTFJ arthrodesis that utilizes the osteoinductive agent recombinant human osteogenic protein (rhOP-1) to help achieve fusion, in conjunction with a fibular osteotomy to unload the PTFJ and to preserve normal rotator mobility of the distal fibula during ankle motion. We have used this technique in two patients with successful results; one of whom required revision after two previous failed attempts at PTFJ fusion and the other who had a previous diagnosis of underlying collagen disorder. Their case studies are presented in detail in this report.
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Demetris
authors.initials: D
authors.lastname: Delos
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington-Harborview Medical Center, Seattle, Washington 98195 USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Schneidkraut
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Rodeo
keywords: OP-1; PTFJ; knee; osteogenic protein-1; proximal tibiofibular joint