Surgical Management of Concomitant Proximal Tibiofibular Instability and Medial Collateral Ligament Tear: A Case Report

Abstract

Introduction: Proximal tibiofibular instability is a relatively rare cause of lateral-sided knee pain, and it can be difficult to diagnose. However, medial collateral ligament (MCL) tears are much more common and are much easier to diagnose. Concomitant management of these injuries, however, is uncommon and not well described. Case report: We present the case of a 26-year-old female who was struck on the lateral side of the knee by a motor vehicle. She suffered a Grade III MCL tear involving both the superficial and deep bands of the ligament, as well as proximal tibiofibular instability. She failed a course of non-operative management with bracing, and the decision was made to proceed with surgery. The procedure entailed peroneal nerve neurolysis, proximal tibiofibular joint stabilization with Tight Rope™ construct, deep MCL repair, and the superficial MCL reconstruction. Conclusion: A heightened suspicion for proximal tibiofibular instability must be had in patients with trauma to the knee and lateral-sided pain. In this case, concurrent MCL reconstruction and proximal tibiofibular joint stabilization were necessary to return the knee to normal kinematics.