Inestabilidad de la articulación tibiofibular proximal en una chica adolescente

Department of Trauma and Orthopaedics, Colchester General Hospital, Colchester, UK

Case history

A 14-year-old girl presented with a 1-year history of right lateral knee pain and giving way, associated with walking and running. She was unable to participate in any sporting activities. There was no history of trauma, but she was actively involved with sporting activities prior to the development of this problem. Clinical examination revealed only mild patellofemoral apprehension and there were no signs of generalised ligamentous laxity. She underwent physiotherapy which did not improve her symptoms. Three months later, repeat examination of the right knee revealed tenderness at the proximal tibiofibular joint and direct posterior pressure over the fibular head resulted in anterior subluxation with a painful clunk. A diagnosis of symptomatic subluxation was made. Examination under anaesthesia (EUA) and reconstruction of the proximal tibiofibular was undertaken. Fig. 1 demonstrates anterior dislocation of the fibular head with posterior pressure at 100° of flexion. A technique similar to that described by Miettinen et al.6 was used to reconstruct the proximal tibiofibular joint. A 10-cm strip of the posterior half of the biceps tendon was tunnelled into the tibia from lateral to medial, and secured with a soft ACL interference screw (Fig. 2). The patient was immobilized in extension non-weight bearing for 2 weeks, following which partial weight bearing and active movements were instituted. Full weight-bearing was allowed at 6 weeks. At 1-year follow-up, the patient is asymptomatic with full return to all sporting activities.