Precision Matters: Comparative Analysis of Fibular Tunnel Trajectories in PLC Reconstruction: A Cadaveric Study.

Abstract

Introduction: Posterolateral corner (PLC) injuries are challenging to manage due to the complex anatomy involved and the need for modified reconstruction to restore knee stability. Current reconstruction techniques vary, with the anterior-posterior (A-P) tunnel placement being widely used. However, newer methods, such as the 50°/60° fibular tunnel trajectory, aim to replicate the natural anatomical insertion points of the fibular collateral ligament (FCL) and popliteofibular ligament (PFL), potentially offering better outcomes.

Methods: This study evaluated the biomechanical effectiveness and procedural safety of the 50°/60° fibular tunnel trajectory compared to the traditional A-P tunnel technique in 18 cadaveric knee specimens. Key outcomes measured included varus opening, neurovascular proximity, and incidence of fibular tunnel blowouts.

Results: The 50°/60° technique significantly reduced varus opening (mean 1.54 mm) compared to the A-P technique (mean 2.06 mm). It also preserved more post-lateral fibular bone stock (7.43 mm vs. 5.10 mm) and did not lead to any tunnel blowouts, while two blowouts were noted in the A-P group. Neurovascular safety was maintained in both techniques, with no significant risk of injury.

Conclusion: The 50°/60° fibular tunnel technique may offer a biomechanical advantage over the A-P technique by providing better knee stability and preserving bone stock. These findings suggest that the 50°/60° method is a safer and more effective option for PLC reconstruction.