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J Knee Surg 2023; 36(08): 878-885
DOI: 10.1055/s-0042-1744220
Original Article

Lateral Collateral Ligament and Biceps Femoris Tendon Fixation with a Suture Anchor to the Tibial Metaphysis after Proximal Fibula En Bloc Resections Preserve Lateral Knee Stability

Kadir Buyukdogan
1   Department of Orthopedics and Traumatology, Koc University Hospital, Istanbul, Turkey
,
Samet Işık
2   Division of Orthopedics and Traumatology, İskilip Atıf Hoca State Hospital, Çorum, Turkey
,
Gökhan Ayık
3   Division of Orthopedics and Traumatology, Bayburt State Hospital, Bayburt, Turkey
,
Mazhar Tokgözoğlu
4   Department of Orthopedics and Traumatology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
,
Mehmet Ayvaz
4   Department of Orthopedics and Traumatology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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Abstract

This study aims to analyze the functional outcomes and lateral knee stability of patients who underwent lateral collateral ligament (LCL) and biceps femoris tendon reconstruction with suture anchors after proximal fibula en bloc resection for bone tumors. Patients who underwent proximal fibular en bloc resection between 2007 and 2018 were retrospectively viewed. Patients were invited to visit the clinic, and their functional scores were evaluated using the Musculoskeletal Tumor Society Scoring (MSTS) system. Lateral knee stability was evaluated by varus stress radiographs obtained at 20 degrees of flexion, and the range of motion (ROM) of the bilateral knee was assessed. Side-to-side differences were graded according to the International Knee Documentation Committee (IKDC) criteria and compared between types I and II resections. A total of 17 patients (4 males and 13 females) with a mean age of 31.1 ± 17.1 (range: 13–65) years at the time of surgery were available for radiological and clinical examination at a mean follow-up of 68.6 ± 36.4 (range: 22–124) months after surgery. In terms of ROM measurements, IKDC grades and side-to-side differences in both flexion and extension were not significantly different between the groups. On varus stress radiographs, lateral knee gapping was measured to be 0.93 ± 0.91 mm in type-I resections and 1.83 ± 0.45 mm in type-II resections, and statistically significant differences were detected among the groups (p = 0.039). When the values were graded according to IKDC criteria, none of the knees were classified as abnormal, and no difference was observed between the groups. Mean MSTS score of patients with type-I resections was significantly higher than those of patients with type-II resections (92.7 vs. 84.4%, p = 0.021). In the subscale analysis, a significant difference was observed in the support scores (type I = 94.5%, type II = 70%; p = 0.001). The reattachment of LCL and biceps femoris tendon to the tibial metaphysis with a suture anchor is a simple and effective method to prevent lateral knee instability after proximal fibula resections.

Keywords

proximal fibula tumor - lateral collateral ligament - suture anchor - en bloc resection

Ethical Approval

All procedures involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. This study is approved by the Hacettepe University Review Board.


Consent to Participate and Publication

All patient provided informed consent before participating in study. All patients gave consent for images or other clinical information to be reported in a medical publication.


Authors' Contributions

M.A. and M.T. operated the patients and designed the study. S.I. and G.A. searched the literature and gathered data. K.B. analyzed the data and prepared the manuscript.




Publication History

Received: 28 December 2020

Accepted: 25 January 2022

Article published online:
10 March 2022

© 2022. Thieme. All rights reserved.

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