Failure of centralization of the fibula [m for congenital longitudinal

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deficiency of the tibia. Epps-C-H-Jr. Tooms-R-E. Edholm-C-D. Kruger-L-M. Bryant-D-D-3d. J-Bone-Joint-Surg- [m[Am]. 1991 Jul. 73(6). P 858-67. J Bone Joint Surg [Am]. Between 1962 and 1983, fourteen patients (twenty knees) had centralization of the [1mfibula [m for congenital longitudinal deficiency: tibial, complete. Eleven of the twenty index procedures were performed on patients who were one year old or less. A progressive flexion deformity of the knee developed after all twenty index procedures. Twenty-six secondary procedures were needed, including disarticulation at the knee, posterior release, extension osteotomy, femorofibular arthrodesis, and biceps-to-quadriceps transfer, and one patient had a second attempt at centralization of the [1mfibula. [m The duration of follow-up after the initial centralization of the [1mfibula [m ranged from four years to twenty-two years and seven months (average, twelve years and four months). Seven patients (eight limbs) in whom the index procedure resulted in failure had a satisfactory result after disarticulation at the knee. The patients who did not have secondary disarticulation at the knee are also considered to have had a failed index procedure because they had a flexion deformity at the latest follow-up. Attempts to reconstruct the knee joint by centralization of the [1mfibula [m are not warranted for patients who have congenital longitudinal deficiency: tibial, complete. Early disarticulation at the knee and fitting with a prosthesis, with close follow-up, is the treatment of choice. Author-abstract.