Transtibial Amputation with Fibulectomy and Fibular Collateral Ligament-Biceps Reconstruction: Surgical Technique and Clinical Experience.

Abstract

To describe our clinical experience and surgical technique of transtibial amputation with fibulectomy and fibular collateral ligament-biceps reconstruction for management of, particularly short, transtibial amputations with proximal fibula prominence, overt instability, or inadequate soft tissue coverage. Retrospective review. Level II trauma center. Twelve consecutive patients who underwent transtibial amputation with fibulectomy and fibular collateral ligament-biceps reconstruction between 2008-2021. We reviewed patient medical records, radiographs, and clinical photographs. Complications, instability, pain. Eight patients underwent acute transtibial amputation with fibulectomy and reconstruction, whereas four patients underwent amputation revision with fibulectomy and reconstruction for chronic pain. All 12 patients were male, with a median age of 39 years [interquartile range (IQR), 33-46]. All injuries were due to high-energy mechanisms, including improvised explosive device (n=8), rocket propelled grenade (n=2), gunshot wound (n=1), and motor vehicle accident (n=1). After a median follow-up of 8.5 years (IQR, 3.4-9.3), there was one complication, a postoperative suture abscess. No patients had subjective lateral knee instability following the procedure and average pain scores decreased from 4.75 to 1.54 (p=0.01). All patients returned to regular prosthesis wear and maintained independent functioning with activities of daily living. Our experience with fibulectomy and fibular collateral ligament-biceps reconstruction demonstrated no subjective or clinical postoperative instability and may be a useful adjunct for managing transtibial amputations with fibular instability or prominence, pain, or skin breakdown at the fibular head. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.