Fibular transfer for congenital absence of the tibia.

Twelve patients (13 extremities) who had complete congenital absence of the tibia were treated between 1963 and 1989. Three patients (three extremities) had a knee disarticulation performed as the primary procedure because they had no quadriceps function. Nine patients (10 extremities) underwent centralization of fibula under the femoral condyles (Brown procedure). Four of these 10 extremities developed a severe flexion contracture of the knee (> 25 degrees) and underwent subsequent knee disarticulation. One patient with a short stump secondary to an ipsilateral proximal femoral focal deficiency had a femorofibular arthrodesis. Five of these 10 extremities had a satisfactory result when reviewed at an average follow-up of 18 years. The patients were evaluated in reference to gait, range of motion (ROM) of the knee, quadriceps strength, prosthetic needs, and peer group sports activities. A strong quadriceps (> grade 4) was noted in all five patients who had a satisfactory result. Flexion contracture of the knee, when < 25 degrees, did not compromise the result.