Biological Stabilization of Proximal Tibiofibular Joint Recurrent Instability with Semitendinosus Graft - Surgical Technique and Case Report.

Introduction: Proximal tibiofibular joint (PTFJ) instability is an uncommon diagnosis of knee pain and is often misdiagnosed. Anatomical reconstruction has been reported to demonstrate improved outcomes with limited complication rates. While the commonly employed anatomical reconstruction methods involve allografts and free grafts, we report the technique and outcomes of anatomical reconstruction of recurrent PTFJ instability management using semitendinosus autograft. Case Report: A 24-year-old young active woman with the instability of the PTFJ underwent stabilization with suspensory loop fixation using a tightrope device along with common peroneal nerve decompression. At 18 months, she reported recurrent instability with episodic knee pain that prevented her sporting activity. She was identified as the failure of the primary stabilization and anatomic biologic reconstruction with semitendinosus was done. The post-operative period was uneventful without any recurrent symptoms the until 1-year follow-up. Conclusion: Non-anatomic reconstruction for PTFJ instability results in late complications like recurrent instability. Semitendinosus can be effectively utilized as the graft of choice for the anatomic reconstruction of the PTFJ ligament complex. Biologic anatomic reconstruction of PTFJ with semitendinosus results in improved clinical outcomes without recurrent complications.