Arciero Technique for Anatomic Posterolateral Corner Reconstruction of Knee Following Femoral Nailing: A Current Technique.

Abstract

Posterolateral corner (PLC) injuries of the knee compromise varus and rotational stability and, if left untreated, predispose patients to persistent instability and failure of cruciate ligament reconstructions. Surgical management is indicated in Grade II and III injuries. The Arciero technique is an anatomic, fibular-based method suitable for Grade II (Fanelli Type B) PLC injuries, reconstructing the lateral collateral ligament (LCL) and popliteofibular ligament (PFL) using a single graft with dual femoral tunnels. We present a 25-year-old male with a Type I open femoral shaft fracture, inferior pole patella fracture, and fibular head avulsion following high-energy trauma. After wound debridement and intramedullary nailing of the femur, MRI demonstrated injury to the LCL and PFL with preservation of the popliteus tendon, consistent with a Grade II (Fanelli Type B) PLC injury. Four weeks later, an anatomic PLC reconstruction was performed using the Arciero technique with an ipsilateral semitendinosus autograft. The Arciero technique remains a reproducible, reliable option for restoring stability close to the native uninjured state and can be safely performed in the presence of a femoral intramedullary nail with appropriate planning.