Proximal tibiofibular stabilization by anatomical ligamentoplasty and diaphyseal osteotomy of the fibula

Proximal tibiofibular instability is a rare condition for which treatment is poorly codified.A 21-year-old patient,a leisure sportswoman,presented a post-traumatic anterolateral instability of the proximal tibiofibular articulation without cartilage lesion.We propose an original surgical technique based on a review of the literature that combines an anatomical ligamentoplasty of the proximal tibiofibular joint and a proximal fibular diaphyseal osteotomy to reduce the distal tibiofibular mechanical stresses.This original technique allows a favorable evolution with recovery of professional and sports activities at 6 months.

Should proximal ruptures of the anterior rectus femoris muscle be treated surgically?

Purpose:No therapeutic consensus has been established about proximal ruptures of the rectus femoris muscle.The objective of this literature review is to determine a therapeutic course of action.Methods:We conducted a literature review on the PubMed database using the following keywords(in French and English,respectively):"quadriceps/quadriceps","droit antérieur/rectus femoris","proximal/proximal","chirurgie/surgical","avulsion/avulsion".We collected 266 articles,36 of them were selected,which were related to our topic:proximal rupture of the anterior rectus femoris.Patients with a proximal rupture of the rectus femoris,minor or major patient of traumatic origin were included in this study.Patients injured at another lesion level,or non-traumatic lesions of the proximal rectus femoris(tendinitis without ruptures,tumor or others)were excluded.For each patient,the indications,the type of treatment and the functional result were analyzed,with the time to recovery and the level of recovery from sports and professional activities(same sport/profession or not,same level or not)as the main criterion of judgment.Fisher exact test was used for statistical comparison.Results:The aims of conservative treatment are to be pain free for the patient,to fight hematoma and to rehabilitate the injury as quickly as possible.The surgical techniques are varied,with most consisting of either a reinsertion of the musculo-tendon stump or a resection of the scar tissue with myo-tendinoaponeurotic suture in place.The functional results are good for the majority of the treatments proposed,but the conservative treatment has a shorter recovery time(3 months vs.4 months for the best surgical results).Highly displaced bone avulsion is the only indication for first-line surgical treatment.Conslusion:The main disadvantage of conservative treatment is the risk of residual pain beyond 3 months(10%),justifying an MRI to guide secondary surgical treatment.We propose a treatment plan for proximal rupture of the proximal rectus femoris rupture.