Proximal tibiofibular joint (PTFJ) instability, although relatively rare, can significantly impair knee function and overall quality of life. This study analyzes the clinical outcomes of 46 patients treated for unilateral PTFJ instability between 2017 and 2021, with a minimum follow-up period of 24 months. The objective was to assess the effectiveness of conservative management and determine the necessity for surgical intervention.
All patients initially underwent non-surgical treatment, including taping and bracing for three months. However, 21 patients (45%) continued to exhibit symptoms post-treatment. These individuals were subjected to additional imaging through MRI and ultrasound, which confirmed persistent instability. Consequently, all patients received prolotherapy at the PTFJ, administered once weekly for three sessions.
At the three-month follow-up, 67% (12 of 18) of these patients showed significant improvement and maintained stability without further intervention. By the final follow-up at 24 months, 93% (43 of 46) of all patients demonstrated marked improvement, with KOOS scores increasing from 71.47±8.67 to 94.23±3.38 (p<0.05) and Cincinnati knee scores improving from 66.11±12.17 to 92.11±4.32 (p<0.05). Three patients continued to experience instability and pain, with one undergoing surgical reconstruction and another requiring total knee arthroplasty (TKA), illustrating the variability in treatment outcomes.
This study highlights the crucial role of accurate imaging in guiding treatment strategies for PTFJ instability. While prolotherapy was effective for the majority of patients, early identification of cases that may require surgical intervention is essential for achieving optimal outcomes. A personalized treatment approach, based on individual patient response and severity of instability, is vital for effectively managing this condition.