Part II: The 50°/60° fibular tunnel trajectory for posterolateral corner reconstruction in a cadaver model

Purpose: Using data from our MRI study, we found that a tunnel oriented 50° externally rotated and 60° cephalad would better connect the fibular collateral ligament (FCL) insertion to the popliteofibular ligament (PFL) insertion as compared to a traditional anterior-to-posterior (A–P) fibular tunnel. The purpose of this study was to test that finding in a cadaver model. Methods: In eight cadaver knee pairs (16 knees), a guide pin was driven from the fibular FCL insertion point in a 50° externally rotated and 60° cephalad trajectory in 8 knees, and in a traditional A–P trajectory in the contralateral 8 knees. Proximity of the pin to the native PFL insertion, the peroneal and tibial nerves was measured, followed by drilling over the guide pin and measuring the remaining fibular bone stock. Results: In comparison with the A–P fibular tunnel technique, the 50°/60° technique resulted in a fibular exit point significantly closer to the native PFL insertion (p < 0.01). Both techniques were safe with regard to the tibial and peroneal nerves. There were no instances of fibular wall blowout in either technique; however, there was less superior bone remaining in the 50°/60° technique (p < 0.04). Conclusion: In a cadaveric model, the 50°/60° technique for PLC reconstruction resulted in a more anatomic-based tunnel than an A–P fibular tunnel.