Impact of proximal tibio-fibular joint injury on posterolateral corner knee reconstructions, strategies for achieving knee stability in combined injuries: a systematic review.

Abstract

Combined injuries of the posterolateral corner (PLC) and proximal tibiofibular joint (PTFJ) are uncommon but can lead to significant knee instability if not properly managed. While anatomical reconstruction techniques are well defined for isolated PLC injuries, the optimal strategy for managing associated PTFJ instability remains unclear. This review aims to evaluate surgical approaches and outcomes for combined PLC and PTFJ injuries. A systematic review was conducted in accordance with PRISMA guidelines. Studies were included if they described surgical management of PLC and PTFJ injuries. Data were extracted regarding patient characteristics, injury mechanisms, surgical techniques, fixation methods, and clinical outcomes. Due to heterogeneity in study design and outcome reporting, a narrative synthesis was performed. Nine studies met inclusion criteria: one cadaveric biomechanical study, three retrospective series, and five case reports. Most injuries were due to high-energy trauma and commonly associated with multiligament knee injuries. PTFJ stabilization techniques included cortical screw fixation, K-wires, suture constructs, and ligament reconstruction. Despite variability in technique, outcomes were generally favorable when PTFJ instability was addressed in conjunction with PLC reconstruction. Functional scores were reported in only two studies. Documented complications included peroneal nerve palsy, hardware-related pain, infection, and arthrofibrosis. PTFJ stability plays a critical role in the success of PLC reconstruction. Stabilizing the PTFJ-regardless of technique-appears essential for restoring knee stability. Given the low methodological quality and heterogeneity of current evidence, further prospective studies with standardized protocols are necessary to guide optimal management of these complex injuries.