The Proximal Tibiofibular Joint: A Biomechanical Analysis of the Anterior and Posterior Ligamentous Complexes.
BACKGROUND
Dislocation of the proximal tibiofibular joint is a complex injury that is often overlooked or misdiagnosed. Surgical management is recommended for severe acute or for chronic symptomatic instability of the proximal tibiofibular joint. Although the anterior ligamentous complex has been reported to be stronger than the posterior complex, biomechanical data are lacking.


OBJECTIVE
To determine the ultimate load of the anterior and posterior ligamentous complexes of the proximal tibiofibular joint to determine optimal graft selection.


METHODS
Controlled laboratory study.


METHODS
Ten nonpaired, fresh-frozen knee specimens were dissected to expose the anterior and posterior proximal tibiofibular ligamentous complexes. The tibia was split in the coronal plane to separate the anterior and posterior ligamentous complexes, and the fibula was left intact. Specimens were secured in a dynamic testing machine and preconditioned for 10 cycles between 2 and 10 N at 0.1 Hz followed by loading to failure at a rate of 25 mm/min.


RESULTS
The mean (±SD) ultimate load of the anterior complex (517 ± 144 N) was significantly greater than the mean ultimate load of the posterior complex (322 ± 160 N) ( P = .012). The mean surface areas of the anterior and posterior complexes were 761 ± 174 mm2and 565 ± 103 mm2, respectively ( P = .008). The mean values for stiffness of the anterior (133 N/mm) and posterior (109 N/mm) complexes were similar ( P = .250).


CONCLUSIONS
The ligaments of the human proximal tibiofibular joint were able to withstand a mean ultimate failure load of 517 ± 144 N for the anterior complex and 322 ± 160 N for the posterior complex. In this regard, it is recommended that the strengths of grafts chosen for proximal tibiofibular reconstructions meet or exceed these values.


CONCLUSIONS
The optimal surgical treatment for addressing residual proximal tibiofibular instability is not well defined. Before an anatomic reconstruction of the proximal tibiofibular ligament is developed, the individual biomechanical properties of the anterior and posterior ligamentous structures of the proximal tibiofibular joint need to be considered to facilitate an optimal reconstruction design.
Steadman Philippon Research Institute, Vail, Colorado, USA.
Daniel Cole
DC
Marchetti
Steadman Philippon Research Institute, Vail, Colorado, USA.|Department of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.|OSTRC, The Norwegian School of Sports Sciences, Oslo, Norway.
Gilbert
G
Moatshe
Steadman Philippon Research Institute, Vail, Colorado, USA.
Brian M
BM
Phelps
Steadman Philippon Research Institute, Vail, Colorado, USA.
Kimi D
KD
Dahl
Steadman Philippon Research Institute, Vail, Colorado, USA.
Marcio Balbinotti
MB
Ferrari
Steadman Philippon Research Institute, Vail, Colorado, USA.
Jorge
J
Chahla
Steadman Philippon Research Institute, Vail, Colorado, USA.
Travis Lee
TL
Turnbull
Steadman Philippon Research Institute, Vail, Colorado, USA.|The Steadman Clinic, Vail, Colorado, USA.
Robert F
RF
LaPrade
D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D007719:Knee Joint / Q000502:physiology*; D008023:Ligaments, Articular / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D019737:Transplants / Q000502:physiology*
biomechanics; knee ligaments; proximal tibiofibular joint