- Discussion:
- proximal tibiofibular joint will prevent valgus correction unless fibula is shortened or tibiofibular ligaments are removed;
-
transection if tibiofibular ligamets: (preferred technique)
- performed thru same incision as for osteotomy;
- proximal tibiofibular joint capsule is disrupted (may also remove inner 1/3 of fibular head), allowing the fibula to migrate proximally;
- tibiofibular ligaments can be sectioned or portion of fibula to which they attach can be removed;
- if large correction is needed, however, fibular head, if retained, may impact on proximal tibial fragment as wedge is closed;
- in the study by A. Billings MD et al. JBJS Jan 2000, not one of 64 knees that underwent high tibial osteotomy (using transection of the
tibio-fibular capsule) developed peroneal nerve palsy;
-
fibular head transection:
- gives clear access to lateral tibial condyle, removes tibiofibular joint and ligaments, and allows for reattachment of
biceps tendon & fibular collateral ligament to neck of fibula under physiological tension;
- w/ this technique, peroneal nerve can be visualized directly;
- the distal cut can be made directly thru the center of the fibular head;
- care is taken to protect the
peroneal nerve;
- often the proximal fibular head fragment will fuse to the proximal tibia, as well as healing to the distal fibular fragment;
-
fibular transection:
- oblique transection in its prox 1/3 to allow overlap as osteotomy is closed;
- be aware of the danger zone of fibular osteotomy which lies between 70 mm and 150 mm
from the fibular head (which endangers nerve branches to the
EHL);
Danger Zones Associated with Fibular Osteotomy.
RE Rupp, D Podeszwa, and NA Ebraheim. J. Orthop Trauma. 1994. Vol 8. No 1. p 54-58.
Palsy of the deep peroneal nerve after proximal tibial osteotomy. An anatomical study.
High Tibial Osteotomy with a Calibrated Osteotomy Guide, Rigid Internal Fixation, and Early Motion. Long-Term Follow-up. A. Billings MD et al. JBJS Jan 2000 Vol 82-A, No 1 Page 70
