Proximal Fibula Resection for Tumors-Case Series and Technical Note

Background: The resection of tumors of the proximal fibula includes the removal of the lateral collateral ligament (LCL) and biceps femoris tendon (BFT) attachment. The aim was to describe and evaluate a surgical reconstruction technique in terms of functional outcome and knee joint stability. Methods: We analyzed the outcome of six patients, treated by a proximal fibula resection. The reconstruction of the attachments of the LCL and BFT was performed with two suture anchors, fixed onto the tibia at the level of the proximal tibiofibular joint (PTFJ). The postoperative knee flexion strength as well as the lateral knee joint stability were compared to the contralateral side using a digital scale and stress X-ray. Patient-reported outcome measures and postoperative complications were documented. Results: No lateral instability and no significant loss of knee flexion strength could be observed (p = 0.075). One persistent postoperative peroneus paresis was reported. High functional outcome was achieved with a mean MSTS score of 92.2%. Conclusions: The resection of the proximal fibula with the reinsertion of the LCL and the BFT using bone anchors in the PTFJ seems to provide a good functional outcome, with a low level of associated comorbidities.