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.

简介 后外侧角 (PLC) 重建中精确的腓骨隧道放置对于恢复旋转和侧向稳定性至关重要。尽管关节镜 PLC 重建技术最近取得了进展，但关节镜腓骨隧道放置的标志以及与开放隧道放置的比较尚未描述。本研究的目的是（1）确定合理的软组织和骨标志，这些标志可以通过关节镜、透视或开放手术在解剖腓骨隧道放置中识别；（2）比较关节镜腓骨隧道放置与开放手术的准确性和可靠性。外科手术。

材料和方法 在一项回顾性研究中，分析了 41 张膝关节磁共振图像 (MRI)，重点分析了理想解剖腓骨隧道与 11 个软组织和骨标志的距离。随后，在八个尸体膝盖上，通过关节镜并采用标准开放技术，使用 2 毫米克氏针从前-后-下到后-中-上创建了理想的腓骨隧道。在介入后计算机断层扫描中比较了两个隧道的位置。

结果 根据 MRI 测量，解剖隧道入口应位于腓骨茎突尖端远端 14.50 (±2.18) mm 处，距腓骨前缘后方 10.76 (±1.37) mm 处。解剖腓骨隧道出口位于腓骨头尖端下方 12.89 (±2.35) mm。在所有情况下，关节镜下腓骨隧道放置都是可靠的。相反，在 8 例开放手术病例中，有 5 例腓骨隧道跨越了到最近皮质边缘/下胫腓关节的规定安全距离（距离 < 8 毫米）。

结论 可靠的腓骨头软组织和骨标志允许在 PLC 手术中进行关节镜解剖腓骨隧道放置，与开放手术技术相比，隧道错位的风险较低。未来的研究必须证明关节镜 PLC 重建的临床结果是否与本研究的技术结果一致。

证据级别 III 级。