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BackgroundPosterolateral corner (PLC) reconstruction of the knee involves precise drilling of a single tunnel from anterolateral to posteromedial in the fibular head (FH) to ensure adequate graft fixation. Misplacement of the tunnel in a too lateral or too superior trajectory can lead to cortical breach and inadequate graft fixation.PurposeTo (1) determine the mechanical consequence of a lateralized FH tunnel in PLC reconstruction and (2) compare the mechanical strength of 3 salvage fixation techniques for a lateralized FH tunnel.Study designControlled laboratory study.MethodsSawbones models of a uniform density were utilized. FH tunnels (7-mm diameter) were drilled from anterolateral to posteromedial in positive controls (lateral cortex thickness, 7.6 ± 0.7 mm) to represent an improperly placed FH tunnel at risk of lateral cortical breach. For negative controls and salvage experimental groups, FH tunnels were drilled from anterolateral to posterolateral (lateral cortex thickness, 2.7 ± 0.9 mm). Three salvage fixation techniques were compared: suture anchor fixation, tunnel redrilling, and nitinol staple fixation. Samples (n = 5 per group) underwent uniaxial tension testing, and the ultimate tensile strength (UTS) and mode of failure were recorded. Data were analyzed using the 1-sample t test and nonparametric 1-sample Wilcoxon signed-rank test.ResultsThe negative control group had a 4-fold lower mean UTS relative to the positive control group (1.49 ± 0.17 vs 6.25 ± 1.98 MPa; P < .01) and exhibited failure through the lateral cortex and tunnel. Nitinol staple fixation improved the mean UTS by >16 times compared with the negative control group (24.06 ± 6.49 vs 1.49 ± 0.17 MPa; P < .01). Suture anchors and tunnel redrilling exhibited similar UTS and mode of failure to those of negative controls.ConclusionReinforcement of a thinned lateral FH cortex with a single nitinol staple improved graft fixation strength in a sawbones model.Clinical relevanceA lateralized FH tunnel can be a common intraoperative pitfall during PLC reconstruction. Salvage of a thinned lateral FH cortex with a single nitinol staple may reduce the risk of cortical breach and graft failure.

Introduction: Osteochondroma is the prevailing noncancerous bone tumour. The tumours originate from the metaphysis and commonly affect the proximal tibia, distal femur, and proximal fibula in the lower extremities. An osteochondroma situated near the fibula can disrupt the typical path of nerves and could result in vascular compression syndromes or paralysis of the peroneal nerve. Case report: We are presenting a case of a 15-year-old male with proximal fibular osteochondroma causing compression of common peroneal nerve leading to neuropathy. Conclusion: We attempt to inform the surgeons on the importance of carefully identifying the entire course of the nerve at the lesion site before removing an osteochondroma located at the proximal fibula to prevent permanent injury to the patient. We recommend that rushing the procedure can result in irreversible damage to the patient. [ABSTRACT FROM AUTHOR]

Abstract Background This is an experimental study conducted to assess whether the fibular head is a reliable reference point to identify the position of the common peroneal nerve at the posterolateral corner of the knee. Materials and methods Twelve cadaveric knees were dissected through the lateral approach. The common peroneal nerve was identified and traced. The location where the common peroneal nerve crossed the posterior border of the biceps femoris and the posterior border of the fibular neck were designated as points B and N, respectively. The tip of the fibular head was designated F. Distances FB and FN were measured and the triangular area FBN was calculated at various degrees of knee flexion. Results During knee motion, distance FN showed minimal change and was not affected by variation in degrees of knee flexion (p = 0.131). Distance FB and distance BN were affected by variation in degrees of knee flexion (p

Background: This is an experimental study conducted to assess whether the fibular head is a reliable reference point to identify the position of the common peroneal nerve at the posterolateral corner of the knee. Materials and methods: Twelve cadaveric knees were dissected through the lateral approach. The common peroneal nerve was identified and traced. The location where the common peroneal nerve crossed the posterior border of the biceps femoris and the posterior border of the fibular neck were designated as points B and N, respectively. The tip of the fibular head was designated F. Distances FB and FN were measured and the triangular area FBN was calculated at various degrees of knee flexion. Results: During knee motion, distance FN showed minimal change and was not affected by variation in degrees of knee flexion (p = 0.131). Distance FB and distance BN were affected by variation in degrees of knee flexion (p < 0.001). Triangular area FBN increased in size up to 60° of knee flexion measuring 621.22 mm2 and subsequently decreased with further knee flexion. Conclusion: The common peroneal nerve can consistently be found at approximately 20.7 ± 1 mm on the fibular neck with respect to the tip of the fibular head. The tip of the fibular head is a consistent landmark that can be used to predict the position of the exit point of the common peroneal nerve at the posterolateral corner of the knee. [ABSTRACT FROM AUTHOR]

Introduction: Injuries to the peroneal nerve are a common complication in operative treatment of proximal tibial or fibular fractures. To minimize the risk of iatrogenic injury to the nerve, detailed knowledge of the anatomy of the peroneal nerve is essential. Aim of this study was to present a detailed description of the position and branching of the peroneal nerve based on 3D-images to assist preparation for surgical approaches to the fibular head and the tibial plateau.Methods: The common peroneal nerve, the deep and the superficial peroneal nerve were marked with a radiopaque thread in 18 formalin-embalmed specimens. Three-dimensional X-ray scans were then acquired from the knee and the proximal lower leg in full extension of the knee. In 3D-reconstructions of these scans, distances of the common peroneal nerve and its branches to clearly defined osseous landmarks were measured digitally. Furthermore, the height of the branching of the common peroneal nerve was measured in relation to the landmarks.Results: The mean distance of the common peroneal nerve at the level of the tibial plateau to its posterior osseous limitation was 7.92 ± 2.42 mm, and 1.31 ± 2.63 mm to the lateral osseous limitation of the tibia. In a transversal plane, distance of the common peroneal nerve branching was 27.56 ± 3.98 mm relative to the level of the most proximal osseous extension of fibula and 11.77 ± 6.1 mm relative to the proximal extension of the tibial tuberosity. The deep peroneal nerve crossed the midline of the fibular shaft at a distance of 22.14 mm ± 4.35 distally to the most proximal extension of the fibula, the superficial peroneal nerve at a distance of 33.56 mm ± 6.68.Conclusion: As the course of the peroneal nerve is highly variable in between individuals, surgical dissection for operative treatment of proximal posterolateral tibial or fibular fractures has to be done carefully. We defined an area were the peroneal nerve and its branches are unlikely to be found. However, specific safe zones should not be utilized due to the individual anatomic variation. [ABSTRACT FROM AUTHOR]

Background: Obtaining an accurate tibial lateral view is important during high tibial osteotomy. This study investigated whether the posterior edge of the medial/lateral tibial condyle (PEMTC/PELTC) and the posterior edge of the fibular head (PEFH) in a lateral view could be a reference for determining the accurate tibial lateral view., Methods: A total of 75 lower limbs in 38 subjects were evaluated in this study. In order to target healthy knees, subjects undergoing primary total hip arthroplasty were selected. The MF/LF, comprising the anteroposterior distance between PEMTC/PELTC and PEFH, was measured on the lateral view of the tibial bone model based on the tibial anteroposterior (AP) axis (true lateral view: TLV). In addition, measurements were calculated in the model with a 10° external/internal rotation. Using these measurements, linear regression analysis was performed to predict the tibial rotation with MF/LF., Results: The mean MF/LF was 0.9/4.6 mm (P < 0.001). MF and LF increased with incremental tibial rotation. Regression formulas were derived from these results as follows: Tibial rotation = (1) -1.01 + 1.06 × MF (R 2  = 0.87, P < 0.001), (2) -8.70 + 1.86 × LF (R 2  = 0.51, P < 0.001). The mean tibial rotation angle when MF was 0 mm was -0.9°., Conclusions: Based on formula (1) and actual measurements, the mean tibial rotation angle when MF is 0 mm is an internal rotation of about 1°. Therefore, a lateral view, in which PEMTC and PEFH are seen colinearly, can be the approximate TLV. The MF can be a suitable intraoperative reference in determining TLV., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Tuberculous osteomyelitis of long tubular bone is uncommon, the reported incidence is about 2-3 %. Tuberculous osteomyelitis of fibular head is very rare and it mimics neoplasm. Here we report a case of a 28 year old male presenting with unremitting right knee pain with swelling around fibular head with knee radiography showing lytic lesion of proximal fibula,excisional biopsy was done and histopathological report confirmed it as tuberculous osteomyelitis. Journal of Society of Surgeons of Nepal, 2015; 18 (2), page: 33-35

Introduction: The projection of the fibular head is recommended as a quality indicator of a correct radiographic projection. However, this landmark has yet to be sufficiently validated.Methods: The MRIs of 334 knee joints were included. On the MRIs, the distance between the FH and lateral tibial cortical bone was simulated in projections parallel to surgically relevant axes. Then, the Pearson correlation coefficient between the distance of the FH to the lateral tibial cortical bone and the projection plane causing this was determined.Results: A projection of the knee joint perpendicular to Akagi's line projected the center of the fibular head on average 4.8 ± 2.9 mm laterally of the tibial cortical bone, parallel to the maximum mediolateral axis of the tibia 7.5 ± 3.4 mm, parallel to the posterior condylar axis 5.6 ± 3.6 mm and parallel to the surgical epicondylar axis 6.1 ± 3.5 mm laterally of the tibial cortical bone. An almost linear correlation was seen, with 1.9° tilting of the projection plane per mm change in distance between the fibular head and tibial cortical bone. At the same time, the interindividual scatter was over 60°.Conclusions: The rule of thumb for a partial overlap of the fibular head by the tibia in the case of a correct antero-posterior projection plane was also confirmed. However, a considerable interindividual variability of the position of the FH was found, which limits a conclusion regarding the quality of the radiographic projection on the basis of the position of the fibular head. [ABSTRACT FROM AUTHOR]