Combined Posterolateral Corner and Proximal Tibiofibular Joint Anatomic Reconstruction: A Surgical Strategy for Complex Posterolateral Knee Instability

Objective Concomitant injury of the posterolateral corner (PLC) and the proximal tibiofibular joint (PTFJ) is a complex clinical entity that currently lacks a standardized surgical treatment. Failure to address PTFJ instability can compromise the result of PLC reconstructions. Therefore, the purpose of this study is to describe a surgical technique for simultaneous stabilization of the PLC and the PTFJ in the setting of a combined injury. Methods An anatomic ligament reconstruction of the PLC and PTFJ was performed on a cadaveric knee specimen using two tendon autografts. Tunnel placement and graft passage were guided by anatomical landmarks. A sequential fixation strategy was implemented, allowing independent graft tensioning and fixation at predetermined knee flexion angles. Qualitative knee stability was assessed comparatively before and after reconstruction using standard examination maneuvers. Results The described technique allowed an anatomic reconstruction of both the PLC and the PTFJ. Reconstruction of the proximal tibiofibular ligaments provided a stable structural base at the fibular head, enhancing the reliability of the PLC reconstruction. Independent graft fixation enabled controlled tensioning consistent with known biomechanical principles. Conclusions This technical note describes an anatomic technique for combined PLC and PTFJ stabilization in a complex injury pattern for which no standardized surgical solution has been defined in the literature. This technique may serve as a foundation for future biomechanical and clinical studies.