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Knee dislocations usually involve anterior and posterior cruciate ligament injury (except in some rare anterior or posterior dislocations) and injury of the lateral and/or medial knee structures. Dislocations imply a high risk of neurovascular lesions and an angiogram is often indicated. This chapter does not deal with knee dislocations where one of the two cruciate ligaments is not torn.

Snapping of the biceps femoris tendon over the fibular head is an uncommon condition. Reported causes include an anomalous insertion of the tendon, trauma at the insertion site of the tendon, and an abnormality of the fibular head. This article reports a case of a painful snapping biceps femoris tendon in a patient without an anomalous tendon insertion or an abnormality of the fibular head. Partial release of the superior aspect of the tendon resulted in resolution of symptoms.

Objective To explore new surgical procedure for repairing and reconstructing medial malleolus and soft tissue defect. Methods According to the size of medial malleolus and composite soft tissue defect, vascular fibular head composite tendon bone flap free grafting using anterior tibial recurrent vessel as the perforating branch was designed to reconstruct the medial malleolar saddle and triangular ligament, and composite back broadest muscle flap free grafting was designed to repair the medical malleolar wound surface. From January 2000 to December 2006, the technique was used in 5 male patients who were injured by machine or in traffic accidents, causing bone and soft tissue defect. The size of wound surface ranged from 19 cm × 12 cm to 24 cm × 12 cm. Results The wound surface was healed at the first stage in 4 cases, and the other case had infection and was cured in 6 months with anti infection therapy. Postoperative follow-ups from 6 months to 6 years showed that grafted bones and free cutaneous flaps were healed well, malleolar joints were stable, joint movement was normal, and the appearance was satisfactory. The overall outcome was good. Conclusion Fibular head composite tendon bone flap free grafting is effective for repairing medical malleolar defect.

We describe a case of popliteofibular ligament (PFL) injury, successfully treated with a new anatomic reconstruction technique looping the biceps femoris tendon (BT). The anterior half of the BT was split longitudinally from the fibular insertion, cut at the proximal end and left attached at the insertion. The proximal end of the BT was looped back in a slit made in the popliteal tendon (PT) at the original anatomical insertion site of the PFL, and passed through the tunnel from the posterior and the baseball suture was tightened on the anterior cortex of fibular head.

Dislocation of the proximal tibiofibular joint is a rare injury, generally seen in patients involved in a high-energy trauma. Seldom is this trauma seen after a minor force. This article describes the clinical presentation, diagnostic tools and treatment of a patient with an isolated dislocation of the fibular head after a minor trauma.

We report a case of acute post-traumatic snapping of the biceps femoris tendon following a soccer injury. Surgical stabilisation, achieved by re-routing the tendon insertion through a tunnel in the fibular head, resolved the symptoms after conservative management failed. We believe this is the first report of a ‘snapping knee’ resulting from direct injury to the biceps femoris tendon insertion.

Objective This study aimed to investigate the feasibility of single incision for plating for the treatment of distal tibia and fibula fractures by a gross anatomic study. Methods The anatomical structures of the anterolateral lower legs were identified. The lower leg length was measured from the top of fibular head to the tip of lateral malleolus. The distances between the extensor digitorum longus and anterior border of distal thirds of the tibia as well as the fibula were also measured. Additionally, their mutual relationships to the surrounding anatomical structures were described. Results The distances from the proximal, middle, and distal thirds of the tibia to the extensor digitorum longus were 2.96 ± 0.46, 1.85 ± 0.25, and 2.15 ± 0.30 cm, respectively; the distances from the proximal, middle, and distal thirds of the fibula to the extensor digitorum longus were 1.82 ± 0.28, 2.09 ± 0.31, and 2.30 ± 0.27 cm, respectively. The results indicated that the safe gap from the distal tibia to extensor digitorum longus (EDL) was 1.6–3.4 cm and from the EDL to fibula was 1.5–2.6 cm. In addition, the average number of vascular pedicle in tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus longus, and peroneus brevis was 2–3. Injuries generated by retracting medially and laterally in vascular pedicle could hardly affect the distal muscles. Conclusions Therefore, we suggest that it is feasible to plate fractures of both the distal tibia and fibula through one anterolateral incision.

Various causes of common peroneal palsy have been described in the English language medical literature in the past. Authors report a case of foot drop in a post cesarean section patient, due to osteochondroma of the proximal fibula, which recovered completely after excision of the offending mass.

Background The proximal tibiofibular joint can be used as a source of osteochondral autograft with little to no morbidity at the harvest site. Methods CT scans of fourteen left and seven right fibular heads, seven right and six left ulnas obtained from healthy subjects were volume-scaled and analyzed. Ipsilateral ulnar articular surfaces were compared between subjects and contralateral ulnas were compared within the same subject. The average deviations between the surfaces were measured. Manual registration and best-fit alignment were used to locate the area on the fibular heads that would best-fit the 50% coronoid process surface. Findings The average deviations in the articular surface between subjects were (mean (SD) 0.79 mm (0.17) and 0.76 mm (0.14) for the left and right ulnas respectively and 0.35 mm (0.07) in the same subject. The average coronoid process height of the scaled ulnas was 15.92 mm (1.15). When comparing the 50% coronoid process with the ispsilateral fibular head geometries, the maximum deviations for all subjects were smaller than 2.0 mm. Two locations were identified as the best-fit locations. Interpretation When volume-scaled, the articular congruency of the proximal ulna articular surfaces between subjects is within the allowable limit for a typical intra-articular fracture step. Results suggest it is possible to use the CT scan of a patient's contralateral elbow as a template to estimate the morphology of the affected side. The fibular head could be an alternative replacement for damaged coronoid process since it is covered by articular cartilage and has locations with a similar curvature as the coronoid process.

Knowledge regarding the anatomy, biomechanics, and diagnosis of injuries to the lateral and medial sides of the knee has expanded greatly during the last few decades. In addition, the surgical techniques for addressing injuries to these structures have improved through biomechanical investigations of reconstruction methods. These topics are systematically addressed with a review and summary of the available literature.

We retrospectively reviewed the results of operative decompression for peroneal nerve palsy in thirty-one patients who had been managed between 1980 and 1990. All patients had been managed non-operatively for at least two months after they had initially been seen. Intraoperatively, we found epineurial fibrosis and bands of fibrous tissue constricting the peroneal nerve at the level of the fibular head and at the proximal origin of the peroneus longus muscle. At a mean of thirty-six months (range, twelve to seventy-two months) postoperatively, thirty (97 per cent) of the thirty-one patients reported subjective and functional improvement and were able to discontinue the use of the ankle-foot orthosis. In contrast, only three of nine patients who had been managed non-operatively reported subjective and functional improvement (p < 0.01). Peroneal nerve palsy does not always resolve spontaneously; if it is left untreated, the loss of dorsiflexion of the ankle and persistent paresthesias can result in severe functional disability. Therefore, if non-operative measures do not lead to improvement within two months, we believe that operative decompression should be considered.

We report a case of a 7-year-old girl in whom a vascularized fibular head with preserved epiphyseal and metaphyseal blood supply was used to reconstruct the missing lateral malleolus. Two-year follow-up showed good bony stability and growth potential of the transplanted epiphyseal plate.

Seven knees with medial osteoarthrosis, in which tibial osteotomy was performed with hemicallotasis over a year previously, were evaluated clinically and radiographically. The average age of patients was 63 years and average follow-up period was 14 months. Femorotibial angle changed from 181 to 167 degrees. JOA knee score improved to 93 postoperatively from 59 points. Hemicallotasis is a method for correcting varus deformity of the proximal tibia. In this method, however, upper displacement of the fibular head occurs and that is a unresolved problem.

Between 1971 and 1991 we treated 98 patients with giant-cell tumours, 15 of whom presented with a pathological fracture. They were most common around the knee (12). Nine fractures were intra-articular. The tumours were treated by curettage and acrylic cementing (10), excision and endoprosthesis (1), excision and allograft (1), curettage and autologous graft (2) or by resection of the fibular head (1). Four patients had local recurrence, three of whom were cured by repeat curettage and cementing. Pathological fracture through a giant-cell tumour is not a contraindication to treatment by curettage and acrylic cementing.

We reconstructed large bony defects of the humerus using a fibula head graft in four cases. In one of the four patients the large bony humeral defect was caused by osteomyelitis of the humerus, while the other three were due to parosseal osteosarcomas of the humerus. Free vascularized proximal fibula grafting was performed in three cases. In the other case a proximal fibula graft using the fibula head was performed. The mean follow-up period was 4·5 years. All cases were evaluated according to their JOA score and the was functionally evaluated reconstructive procedure following surgical treatment of the musculoskeletal tumor according to Enneking.In two patients under 40 years of age both the JOA score and % Rating of Enneking's evaluation were significantly higher than in patients aged over 40 years.We concluded that a free vascularized fibula graft is a very useful procedure for treating large bony defects of the humerus.

Objective To establish the diagnostic cutoff value of ultrasonographic measurement for common fibular neuropathy (CFN) at the fibular head (FH). Methods Twenty patients with electrodiagnostically diagnosed CFN at the FH and 30 healthy controls were included in the study. The cross-sectional area (CSA) of sciatic nerve at mid-thigh level, common fibular nerve at popliteal fossa (PF), and common fibular (CF) nerve at FH were measured. Additionally, the difference of CF nerve CSA at the FH between symptomatic side and asymptomatic side (ΔSx–Asx), the ratio of CF nerve CSA at FH to at PF (FH/PF), and the ratio of CF nerve CSA at the FH symptomatic side to asymptomatic side (Ratio Sx–Asx) were calculated. Results CSA at the FH, FH/PF, ΔSx–Asx, and Ratio Sx–Asx showed significant differences between the patient and control groups. The cutoff value for diagnosing CFN at the FH was 11.7 mm2 for the CSA at the FH (sensitivity 85.0%, specificity 90.0%), 1.70 mm2 for the ΔSx–Asx (sensitivity 83.3%, specificity 97.0%), 1.11 for the FH/PF (sensitivity 47.1%, specificity 93.3%), and 1.24 for the Ratio Sx–Asx (sensitivity 72.2%, specificity 96.7%). Conclusion The ultrasonographic measurement and cutoff value could be a valuable reference in diagnosing CFN at the FH and improving diagnostic reliability and efficacy.

The lateral supporting structure of the knee is a compound of several ligaments and tendons and thus is more complex than the medial supporting structure.

Aesthetic surgery is an aggregate of medical specialties united by the purpose of implementing the ideas of a healthy person about physical perfection by means of operative intervention [375] Aesthetic surgery of the lower extremities can be considered as an integral part of orthopedics and plastic surgery.

Cranial transposition of the fibular head stabilizes the stifle joint by displacing the distal attachment of the lateral collateral ligament (LCL). The forces applied to the LCL after displacement may cause ligamentous elongation. This investigation evaluated the morphological, histological, and biomechanical changes of the LCL after fibular head transposition (FHT) in dogs. Unilateral cranial cruciate ligament (CCL) excision and FHT were performed on 25 dogs. Cross-sectional area, length, histological, and structural properties of the LCL were evaluated 3 weeks, 4 months, and 10 months after surgery. Ligament length means were significantly increased at week 3, month 4, and month 10 compared with intraoperative length means. No significant changes in elongation were observed after week 3. Fibrovascular proliferation within the LCL increased the cross-sectional area and associated structural properties.

Common peroneal nerve palsies may arise from numerous causes. We report an unusual case of common peroneal nerve palsy secondary to a previously unreported congenital band crossing the nerve at the level of the fibular head.

Persistent pain development after a skeletal contusion rarely poses the diagnosis of osteomyelitis. We report the case of a fibular head contusion as an initial manifestation of a focal abscess development in a healthy young patient. The traditional treatment of surgical drainage revealed the presence of an atypicalMycobacterium haemophilumisolates in the abscess. This lead to further investigations that concluded and established the diagnosis of AIDS.Conclusion. Isolation of an atypicalMycobacterium haemophilumin any abscess should lead the physician to accomplish further investigations and look for AIDS even in young healthy subjects.

It is estimated that only 24% of practitioners use CAD/CAM regularly. Socket manufacturing error may be a source of the limited use of central fabrication.The purpose of this study was to investigate the differences in shape between computer-manufactured, centrally fabricated carved models and electronic file shapes, to determine if carving was a major source of socket manufacturing error in central fabrication.Experimental, mechanical assessment.Three different trans-tibial model shapes were sent electronically to each of 10 central fabrication facilities for the fabrication of positive foam models. A custom mechanical digitizer and alignment algorithm were used to measure the model shapes and then compare them with the electronic file shapes.Volume differences between the models and the electronic file shapes ranged from -4.2% to 1.0%, and averaged -0.9 (SD = 1.1)%. Mean radial error ranged from -1.2 mm to 0.3 mm and averaged -0.3 (SD = 0.3) mm. Inter-quartile range was between 0.3 mm and 2.7 mm and averaged 0.6 (SD = 0.5) mm. The models were significantly smaller than sockets made from the same electronic file shapes (p 0.01), but the range of mean radial error and the interquartile range were not significantly different between the models and sockets.The results demonstrated that there was considerable variability in model quality among central fabricators in the industry, and that carving was not the sole source of socket fabrication error.The results provide insight into the severity and nature of carving error by central fabrication facilities. Because we found a wide range of model quality, there is not a consistent fabrication problem across the industry, but instead some central fabrication facilities practice the art of model fabrication better than others.

Background: Designing a reliable fibula flap skin paddle can be challenging because of the lack of information on precise perforator locations. The purpose of this study was to precisely map the perforators and provide a simple and reliable method for skin paddle design. Methods: Eighty consecutive patients undergoing free fibula flap reconstruction were included in this prospectively designed study. The location, size, and type of perforators were recorded intraoperatively and mapped on the line connecting the fibular head and lateral malleolus. Results: There were 46 male and 34 female patients with a total of 202 perforators. The average length of the fibular head and lateral malleolus line was 36.1 ± 3.4 cm (male patients, 38.2 ± 2.2 cm; female patients, 34.1 ± 2.7 cm). Two discrete groups of perforators could be identified. The proximal perforator was consistently found one-third the length and 1.5 cm posterior to the line. The majority of these perforators (84 percent) were musculocutaneous. The more clinically useful perforators to support a skin paddle are the distal ones over the third quarter of the fibula. One to three distal perforators were consistently present, grouped as perforators A, B, and C at points 0.51, 0.62, and 0.73 along the line, respectively. Perforators were approximately 3.5 cm apart and 2 cm posterior to the line, and the majority (96 percent) were septocutaneous. Conclusions: Using common anatomical landmarks, a reliable skin paddle can be designed with simplicity and confidence over the third quarter of the fibula. The proximal perforator can be useful as a second skin paddle for through-and-through reconstruction.

Objective To investigate the injury mechanism in patients who had peroneal neuropathy after a tibio-fibular fracture and the correlation between tibio-fi bular fracture location and the severity of the peroneal neuropathy by using electrodiagnosis. Method Th irty-four patients with peroneal neuropathy after a tibio-fi bular fracture were recruited for this study. Their medical records, radiologic and electrodiagnostic findings were investigated retrospectively. They were divided into 2 groups according to the existence of a fibular head fracture. The group of patients without the fibular head fracture was further classified according to the criteria of Orthopedic Trauma Association (OTA) classification. The differences between the two groups in the severity of the neuropathy and electrodiagnostic fi ndings were evaluated. Results Nine cases (26.5%) had tibio-fi bular fractures with a coexisting fi bular-head fracture and 25 cases (73.5%) had tibio-fi bular fractures without fractures in the fi bular-head area. Th ere was no statistical signifi cance in the correlation between the existence of the fi bular head fracture and the severity of the electrodiagnostic fi ndings. Neither was there any statistically significant relationship between the site of the tibio-fibular fracture and the severity of the peroneal neuropathy (p>0.05). Conclusion This study showed there were numerous cases with common peroneal neuropathy after tibiofi bular fracture without a coexisting fi bular-head fracture, which shows the importance of indirect nerve injury mechanisms as well as that of direct nerve injury as a cause of peroneal neuropathy. In addition, this study showed that there was no statistically signifi cant correlation between the site of tibio-fi bular fracture and the severity of peroneal neuropathy.

A magnetic resonance imaging study of 50 Chinese normal knees was conducted to determine the knee joint line position. The distances from the fibular head and the tibial tubercle to the joint line were measured, and each distance value was converted to a ratio relative to the anteroposterior tibial widths at the levels of the insertion of the patellar tendon and the apex of the fibular head. The distance to the joint line was 11.99 ± 1.20 mm from the fibular head and 20.48 ± 1.64 mm from the tibial tubercle. The fibular head and tibial tubercle are reliable landmarks. The distances and ratios can be used to determine the knee joint line position in revision surgery for the Chinese population.

Posterolateral corner (PLC) injury of the knee causes varus and posterolateral rotatory instability. The anatomy of the PLC has been reported in the literature but the importance of PLC reconstruction has only recently been established and ideal reconstruction techniques are still in development. The native function of the PLC is to restrain varus and external rotation. Reconstruction methods should properly restore these functions without overconstraining the joint. Several reconstructions for PLC injury have been reported but with concerns of iatrogenic neurovascular injury, fibular head cutout, and restoration of the knee kinematics. To address these concerns, a new cross fibula tunnel method was developed that may have lower risk of iatrogenic nerve injury and fibula head cutout. The purpose of this study was to verify the stability of this technique using a PLC deficient knee.Copyright © 2010 by ASME

Peroneal nerve palsy following knee dislocation is a serious problem, and neurolysis at the time of knee reconstruction does not always result in return of peroneal nerve function. We describe peroneal nerve pathoanatomy in three patients in whom late exploration of the peroneal nerve was performed because of ongoing absence of ankle dorsiflexion. We identified frank nerve rupture in two patients and a lengthy neuroma in continuity in one which extended far proximal to the fibular head and well above the previous surgical incision used for peroneal nerve neurolysis at the time of knee reconstruction. In light of the current state of microneural surgery and the potential to reconstruct nerve defects, we discuss how our findings impact on treatment, and provide recommendations which may improve recovery of peroneal nerve function in future cases.

A common peroneal nerve block at the fibular head is uncommon in clinical practice. The case of a 41 year old, morbidly obese woman requiring right total ankle replacement is presented. Ultrasound-guided common peroneal nerve block was performed at the fibular head after an unsuccessful popliteal approach.

In this report, an original technique for augmentation of chronic biceps femoris tendon avulsion is described. The procedure is developed using a reverse fascia flap of biceps femoris to be a single-tailed graft. Then, a suture anchor is inserted on the fibular head to approximate and fix the retracted the biceps femoris. Finally, a tunnel is drilled at the proximal fibula to let the graft pass through, and the end of the graft loop is sutured to itself. This technique confers effective, firm fixation of chronic biceps femoris tendon avulsion.

We report an unusual association of peroneal mononeuropathy at the fibular head and the use of antithrombotic stockings. A patient developed clinical evidence of a peroneal nerve deficit temporally related to the use of a tight-fitting antithrombotic stocking. Nerve conduction studies and needle electromyography were performed. A peroneal mononeuropathy at the fibular head was confirmed and demonstrated mixed axonal and demyelinatmg features. Antithrombotic stockings are an unusual cause of peroneal mononeuropathy, Early recognition of this complication may improve outcome.

No Abstract.Nigerian Journal of Surgical Sciences Vol. 18 (1) 2008: pp. 54-57

Total knee replacement is a demanding surgical procedure, with high morbidity and cost. Often patients and their families as well as healthcare personnel experience a false perception of low risk, extrapolating from the rather uneventful operative and post-operative courses of primary total knee replacement in the non-hemophiliac patient. When performed in hemophilia treatment centers in the hands of experts, a total knee arthroplasty may yield moderate results, with infection rates of about 13% in HIV-negative patients and survival rates of about 77% at 10 years [1, 2, 3]. However, reproducing these results requires a sophisticated medical environment and an experienced hemophilia treatment group. An inexperienced surgeon may engage in this procedure, wrongly assuming that as long as the patient’s coagulopathy has been corrected, everything else will be the same as in a non-hemophiliac patient. This is not the case. Total knee arthroplasty in the hemophiliac requires additional planning, deviation from the standard surgical routine, and familiarity with a combination of technical difficulties seldom found in other conditions. My purpose in this chapter is to outline the technical difficulties that co-exist in total knee arthroplasty in hemophilia, so the reader may prepare for the surgical procedure.

Introduction One of the primary functions of the proximal tibiofibular joint is slight rotation to accommodate rotational stress at the ankle. Proximal tibiofibular joint dislocation is a rare injury and accounts for less than 1% of all knee injuries. This dislocation has been reported in patients who had been engaged in football, ballet dancing, equestrian jumping, parachuting and snowboarding. Case presentation A 20-year-old man was injured whilst playing football. He felt a pop in the right knee and was subsequently unable to bear weight on it. The range of movement in his knee joint was limited. Anterior-posterior and lateral X-rays of the knee revealed anterolateral dislocation of the proximal tibiofibular joint. Comparison views confirmed the anterolateral dislocation. He had a failed manipulation under anaesthesia and the joint needed an open reduction in which the fibular head was levered back into place. Operative findings revealed a horizontal type of joint. Conclusion An exceedingly rare dislocation of a horizontal type of proximal tibiofibular joint was presented following a football injury. This dislocation was irreducible by a closed method.

Forty embalmed cadaver lower limbs were dissected to identify the morphology of the conjoint junction of the tendons of gastrocnemius and soleus and the location of the gastrocnemius tendon relative to bony landmarks. Five patterns of conjoint junction morphology were found: transverse (25%), oblique passing distally and medially (45%), oblique passing distally and laterally (5%) and arcuate as an inverted U (17.5%) and a U-shape (7.5%). Left-right asymmetry of the junction was observed in 31.6% of 19 paired cadaver legs. On the medial side of the calf the gastrocnemius tendon could be located between 38 and 46% of the proportion of the distance between the upper border of the calcaneus and the fibular head. Corresponding values for the midline and lateral side of the calf were 45-58% and 48-51%. The location of the gastrocnemius tendon relative to bony landmarks may help to guide incision planning for open or endoscopic division of the tendon.

We report a case of an avulsion of part of the fibular head during a primary total knee replacement for osteoarthritis. Post-operatively the patient developed a foot-drop. However, there was no clinically demonstrable instability of the knee. The patient was managed conservatively, the foot-drop recovered completely and the knee remained clinically stable. We observed that excessive hyperextension and/or a varus strain on the knee during pressurisation while cementing could have led to the injury. We advise caution while using this manoeuvre for pressurisation. This is the first injury of its kind reported in the literature.

We describe a previously unreported anatomical variant of the peroneal artery that was found both on preoperative angiography and at operation to be related to the fibula only in its distal third. In contrast to previously reported variations, the artery began descending on the medial aspect of the fibula about 26 cm from the fibular head.

In 10 consecutive patients with footdrop due to common peroneal neuropathy without an obvious cause, MRI of the knee showed pathology at the fibular head in 6, including 5 patients with clinically unsuspected cysts of the tibiofibular joint. All 6 of the patients improved with surgery.

Background Anatomical reconstruction of a ruptured lateral collateral ligament using allograft tissue secured within the fibular head with an interference screw has been described. Hypothesis Interference fixation at the fibular head does not reproduce the strength of the intact ligament. Study Design Controlled laboratory study. Methods Ten intact lateral collateral ligaments were tested to failure. The distal fixation of 11 ligaments reconstructed with a graft including a bone plug and 11 ligaments reconstructed with a graft without a bone plug were also tested. Results The reconstructed ligaments consistently failed at the fibular head. The intact specimens predominately failed through ligament rupture. The mean strength and stiffness values were 460 ± 163 N and 82 ± 25 N/mm, respectively, for the intact ligaments, 113 ± 40 N and 36 ± 10 N/mm, respectively, for reconstruction with a bone plug, and 135 ± 81 N and 34 ± 14 N/mm, respectively, for reconstruction without a bone plug. The strength and stiffness were significantly (P Conclusion Tension applied to lateral collateral ligaments reconstructed using fibular interference fixation should be limited immediately after surgery. Soft tissue fixation should be employed with care because of the inconsistency in the failure strength. Clinical Relevance Although fibular interference fixation is increasingly being described in the literature, the properties of reconstructed lateral collateral ligaments have not previously been quantified.

Background. The most common entrapment in the lower extremity is peroneal mononeuropathy (PM) at the fibular head. Several studies of this condition have been published but, until now, no wide multicenter clinical-neurophysiological studies on PM are available. In recent years, multicenter studies have been suggested; moreover it is commonly accepted that a multiperspective approach provides more comprehensive results.

The quality of fit of a trans-tibial patellar-tendon-bearing (PTB) socket may be influenced by consistency in casting, rectification or alignment. This paper quantifies, for the first time, the variations in the rectified casts between two experienced prosthetists and the variation between the rectified casts of each individual prosthetist. Prosthetists A and B observed the hand casting of a typical trans-tibial amputee. Each prosthetist was supplied with 5 previously measured duplicated plaster models. The two prosthetists rectified the supplied plaster models based on their own interpretation of basic rectification guidelines. Both prosthetists operated in isolation. The re-measured rectified plaster model data was compared with the unrectified data. The extent of rectification at each of 1800 locations per plaster model was calculated. In zones of major rectification, the mean difference between prosthetists was quantified as 2mm and the standard deviation (SD) about that mean was +/- 1mm for each prosthetist. The co-ordinates of the apex of the fibular head for the 10 modified casts indicated that the maximum variation was in the axial direction with a SD of 4.3mm for prosthetist A and a SD of 2.8mm for prosthetist B. The lengths of the 5 plaster models rectified by prosthetist A indicated a SD of 0.2mm whereas the lengths of the 5 plaster models rectified by prosthetist B indicated a SD of 2.9mm.

Injury to the proximal tibiofibular joint is typically seen in athletes whose sports require violent twisting motions of the flexed knee. Instability of this joint may be in the anterolateral, posteromedial, or superior directions. With acute injury, patients usually complain of pain and a prominence in the lateral aspect of the knee. A closed reduction should be attempted in patients with acute dislocation. If this is unsuccessful, open reduction and stabilization of the joint with repair of the injured capsule and ligaments can be done. Patients with chronic dislocation or subluxation report lateral knee pain and instability with popping and catching, which may be confused with lateral meniscal injury. Symptoms of subluxation may be treated nonsurgically with physical therapies such as activity modification, supportive straps, and knee strengthening. For patients with chronic pain or instability, surgical options include arthrodesis, fibular head resection, and proximal tibiofibular joint capsule reconstruction.

Tumors of the proximal fibula are rare. Wide resection includes adjacent knee-stabilizing structures. Unlike treatment of traumatic disruption of the lateral ligamentous structures of the knee, wide resection of the fibular head for a tumor may not require reconstruction. After 1–4 years of follow-up, function was satisfactory in 6 consecutive cases where resection of the fibular head was done without ligamentous reconstruction.

Anatomical reconstruction of the popliteus tendon and the popliteofibular ligament (PFL), using a split semitendinosus tendon graft.

Results: Among the 494 cases of the knee MRI, there were 433 (87.65%) type I cases, 21 (4.25%) type II cases, 2 (0.4%) type III cases, 16 (3.23%) type IV cases, and 22 (4.45%) type V cases. There were 26 cases (5.26%) in which the LCL and BFT were not attached into the fibular head. Conclusion: The fibular attachment pattern of the BFT and LCL shows diverse types in MR imaging. The LCL does not adhere to the head in some patients.