PMC6349988_01
Bilateral radiographs demonstrating absence of the left fibula. Red lines approximate graft placement. (a) Anterior-posterior (AP) view and (b) lateral view.
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Bilateral imaging of the legs revealed an absent left fibula (Figure 1).
Photograph demonstrating marked limb-length discrepancy.
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A photo of the legs demonstrates the marked difference in limb length (Figure 2).
(a) ITB autograft measuring 120 mm in length and 10 mm in width. (b) Semitendinosus allograft was used to augment the ITB autograft.
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After incision and exposure of the lateral thigh, a portion of the ITB was harvested producing a graft, 120 mm in length and 10 mm wide (Figure 3(a)). As the graft was considerably small in cross-section, and the anterior tibial laxity was quite significant, the decision to use a semitendinosus allograft to augment the reconstruction was made (Figure 3(b)).
(a) Augmented graft prior to suturing into periosteum. (b) Arthroscopic examination of the knee joint revealing cruciate ligament aplasia.
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Arthroscopic examination of the knee was consistent with the clinical examination finding of complete absence of both the cruciate ligaments (Figure 4(b)). After the graft was secured to the tibia with sutures in the periosteum (Figure 4(a)), the Lachman exam was repeated and the anterior laxity of the tibia on the femur had been minimized.