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J Knee Surg 2023; 36(09): 977-987
DOI: 10.1055/s-0042-1748897
Original Article

Comparison of Arthroscopic versus Open Placement of the Fibular Tunnel in Posterolateral Corner Reconstruction

Matthias Krause   *
1   Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Sebastian Weiss    *
1   Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Jan Philipp Kolb
1   Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Ben Schwartzkopf
1   Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Jannik Frings
1   Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Klaus Püschel
2   Department of Legal Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
,
Etienne Cavaignac
3   Department of Orthopaedic Surgery and Trauma, Clinique Universitaire du Sport, Hôpital Pierre Paul Riquet, Toulouse, France
,
Bertrand Sonnery-Cottet
4   Centre Orthopédique Santy; FIFA Medical Center of Excellence; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
,
Karl-Heinz Frosch
1   Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
5   Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum, Hamburg, Germany
› Author Affiliations
Funding None.
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Abstract

Introduction Precise fibular tunnel placement in posterolateral corner (PLC) reconstruction is crucial in restoring rotational and lateral stability. Despite the recent progress of arthroscopic PLC reconstruction techniques, landmarks for arthroscopic fibular tunnel placement and a comparison to open tunnel placement have not yet been described. This study aimed to (1) identify reasonable soft-tissue and bony landmarks, which can be identified by either arthroscopy, fluoroscopy, or open surgery in anatomic fibular tunnel placement and (2) to compare accuracy and reliability of arthroscopic fibular tunnel placement with open surgery.

Materials and Methods In a retrospective study, 41 magnetic resonance images (MRIs) of the knee were analyzed with emphasis on distances of an ideal anatomic fibular tunnel to 11 soft-tissue and bony landmarks. Subsequently, in eight cadaver knees, the ideal fibular tunnel was created arthroscopically and with a standard open technique from antero-latero-inferior to postero-medio-superior with a 2-mm K-wire. Positions of both tunnels were compared on postinterventional computed tomography scans.

Results Based on MRI measurements, the anatomic tunnel entry should be 14.50 (±2.18) mm distal to the tip of the fibular styloid and 10.76 (±1.37) mm posterior to the anterior edge of the fibula. The anatomic fibular tunnel exit was located 12.89 (±2.35) mm below the tip of the fibular head. Arthroscopic fibular tunnel placement was reliable in all cases. Instead, in five out of the eight cases with open surgery, the fibular tunnel crossed the defined safety distance to the closest cortical edge/tibiofibular joint (distance < 8 mm).

Conclusions Reliable soft-tissue and bony landmarks of the fibular head allow arthroscopic anatomic fibular tunnel placement in PLC surgery, which shows a lower risk of tunnel malposition compared with open surgical techniques. Future studies will have to show whether clinical results of arthroscopic PLC reconstruction are in line with this study's technical results.

Level of Evidence Level III.

Keywords

posterolateral corner - anatomic reconstruction - soft-tissue and bony landmarks - fibular tunnel

* both authors contributed equally.




Publication History

Received: 09 September 2021

Accepted: 18 March 2022

Article published online:
07 July 2022

© 2022. Thieme. All rights reserved.

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