Name: Posterolateral Corner Reconstruction: Knee FiberTak® Anchors and FiberTag® TightRope® II PF Implant
Uploaded: 2026-02-25T00:00:00Z
Channel: Arthrex
Description: Bruce A. Levy, MD (Orlando, FL), performs a posterolateral corner reconstruction using a Double Knotless Knee FiberTak® anchor and the FiberTag® TightRope® II PF implant with a curved needle.

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Bruce A. Levy, MD (Orlando, FL), performs a posterolateral corner reconstruction using a Double Knotless Knee FiberTak® anchor and the FiberTag® TightRope® II PF implant with a curved needle.

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video

VID1-008791-en-US | A | Posterolateral Corner Reconstruction: Knee FiberTak® Anchors and FiberTag® TightRope® II PF Implant

Bruce A. Levy

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

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Posterolateral Corner Reconstruction: Knee FiberTak® Anchors and FiberTag® TightRope® II PF Implant

Speaker  Hi, I'm Bruce Levy from the Orlando Health Jewett Orthopaedic Institute, and today we're going to demonstrate a new posterolateral corner reconstruction technique using some of Arthrex newest and greatest innovations for the Popliteus. We're going to show you the Onlay fixation technique using the double knotless knee fiber tack anchor for the LCL. We're going to show you the fiber tag tightrope two PFC with a curved needle, which really allows you insight to easier preparation than a straight needle. And we're going to demonstrate how attentions towards the loop. And finally we're going to demonstrate the loop link suture for it band closure. So we've got a right knee cadaveric specimen here. And I'll just briefly go over the classic anatomy for the post coronal reconstruction. So as you can see here we've got the nerve all exposed. And as we've mentioned in previous videos, it's really important that you free the nerve all the way to the peroneus fascia. You can see the fascia, the muscle, and then there's a slightly deeper fascia layer just under here that you want to release the nerve at the fibular tunnel. We've already gone ahead and drilled a six millimeter fibular tunnel after we identified the LCL right here. As you can see beautifully through the biceps Bursa. So here's the biceps. We go through the biceps Bursa, find the LCL, trace it down and get to our anatomic landmarks. So here's biceps. Speaker  Here's the IT band which we've come through right through the mid portion all the way to Gerdy's tubercle. Then we come through the capsule. You can see here we've got the distal femur. And in the snap right here I've got the popliteus. Now the popliteus attaches in the anterior fifth of the kidney bean popliteal sulcus. And so that's right where we're going to drill for the onlay technique. And again we're going to use the double knotless knee fiber anchor and Onlay. The Popliteus. Here we're going to take the double knotless knee fiber tack drill right in the anterior fifth of the Popliteus socket, right above the anatomy here. Okay. And we're going to aim just slightly proximal and slightly anterior. And we're going to drill in to a depth of 25mm. Now we're going to come out and we're going to insert the anchor. We're just going to set the system. There we go. I felt just a tiny little pop right there. And now we are all set to place our graft. And what we've done is we've got our graft here and we've measured this 1 to 6mm. And I'll often put a little mineral oil, water soluble at the end of the graft to help with passage. And we just have a little fiber loop here holding the end. So I've already passed a passing suture through the popliteal hiatus. Speaker  Now, one of the key things about this is you want to be on the anterior aspect. You see where we are, there's popliteus and here's the anterior aspect. And there is meniscus. So right at the popliteal hiatus, you come through to the back behind the fibula. Okay, so we'll go ahead and start passing our graft. And now we're going to pass that through the popliteal hiatus. Now we've already passed suture through the fibula. So we'll go ahead and pass that. And this tends to be the hardest part of the passage coming through here. And then we're going to just dock this because this is going to come after for our LCL. And we'll just leave that laying nicely here. And now we're ready to go ahead and do the onlay technique. It's one of the first things we have to do is grab a little suture here. And this is going to help create our luggage tag. And we're going to even those out. And then we're going to go ahead and pass it through this free needle. And that is going to help us create a luggage tag with one of the loops of the Knotless fiber tag. And at this point, now I'm going to pass this suture about two centimeters through the graft. And then we're going to put this right over the top of the graft. So now it's important that we figure out which of these limbs is going to tension. Speaker  So if I give a gentle pull I can see that this is the one that's going to tension. And we're going to walk the graph down all the way till it gets to the bone. And then I'm going to go ahead and cinch this down. And there we have super tight super snug. I am really, really yanking on that. And then we're going to take the extra limb and we're going to grab the other loop now. And we now have double fixation. And that, ladies and gentlemen, is outstanding fixation. And at this point now you can either cut the excess or we can actually just suture that back down to itself. So now we're going to do is we're going to pass the graft under the IT band and coming through the biceps Bursa. You recall we've identified the LCL. So we literally just create a track right along the LCL up to its insertion site. And so now we're basically mimicking the trajectory of the LCL. And at this point now we're going to find our isometric point just proximal and posterior to the lateral epicondyle which I've identified clinically with this blue mark. So I'll take a two for guide pin. And we'll check our isometric position. Now notice that I'm going to be aiming proximally and anteriorly approximately 35 degrees, and we'll mark our graft and go ahead and extend the knee. Speaker  And now flex the knee. And you see how we're just slightly tensioning in flexion. So that looks perfect. So we'll go ahead now and we can drill our socket. Just to confirm you can see here that we're right around just under two centimeters maybe 17 to 18mm, which is typical in a normal sized patient. And one of the beautiful things about having onlay technique in one of these sockets is that in a small patient, I'm going to drill this to about 40 here. There we go. In a small patient, these can get pretty close, these two sockets. And so having one being an onlay is a huge advantage here. Now notice that I put the two four pin in first and then I'm drilling. And now I'm going to put the spade tip blade in. You saw that you have to kind of set yourself perpendicular to the bone with your two four guide pin, and then move it anterior and proximal. It's really hard to do that with the spade tip. So I do the two four pin first, then drill the tunnel. And now I'm going to go ahead and use the spade tip guide pin. And we'll come in here. And I can feel the cortex and I'm through. And the osseous length here is right around 6065. And now we can take a passing suture and go ahead now and pull that across. Speaker  We'll keep the loop end on this side and we're ready to go. This was the original mark for our isometry. Notice it's right at the entrance of the tunnel. And the fiber tag tightrope is two centimetres long so I want to go at least 25. Remember I drilled to about 40. So here I've marked this at 25. And now we'll go ahead and amputate this part of the graft. So here we are with the new fiber tag tightrope two PFC with curved needle. This will tension conventionally similar to the original ACL tightropes. And the beautiful thing about this is that when you are in situ, you don't have the straight needle coming at you. We're going to have the curved needle. And so this is the main advantage of this device. So we're going to take it out of the card. And here it comes. Now we're going to load the tightrope. Similar to any fiber tag tightrope technique using the special tenaculum. And now we're going to take this end right in the center and doc it in. And it's critical, as you can see here, that we have not snagged any of the white sutures. And now we're going to go ahead and lay it on like so. Now we'll take a needle driver and we're ready to go. Similar to any of the fiber tech tightropes, I'm just gently laying the fiber tag against the graft. Speaker  And I'm going to start my loop just proximal to that through tissue. And here we're going to go ahead and just seed it. And that looks perfect there. So we'll come through the loop. And now the second pass here and then our next pass. And now we're going to come through the card. And now we're going to come past the graft. We're going to cut one end. Now we'll go ahead and cut the free end. And then I will bury the knot and cut. So now we're going to go ahead and get rid of the Tenaculum. And we'll get rid of the card here. Now remember that we measured 65. So we'll probably have to extend that a little bit. But let's go ahead and trim these little tails. We're going to resize. Remember we drilled to a seven and it's nice and smooth. So we're good there. And now we're ready to extend this a little bit. We needed 65. We're at 55. So we're going to go ahead and lengthen this just a tad. We're going to measure 65 from the tip right about there. And so now we have plenty of length. Unlike the newer Tightropes, remember that the tensioning is going to come through the lateral side, so we're only going to pass the blue sutures here. Speaker  Pull the blues through. Great. Now go ahead and pull the black. Pull that across. And I'll just keep some counter tension right here. And I can feel it right up against the cortex and pop. So now I've got nice fixation before we tension. We're going to secure the fibular screw while we still have a little play in the system here. We're going to tension here at about 60 degrees. So this is in the collateral ligament set. It's a beautiful retractor. Sits right in front of the gastroc. And now we'll see nitinol wire. We'll pass that through. It's right up against the retractor and then we'll load a screw. I typically go line to line. If the bone is soft or down, if the bone is hard. So if it's a seven, I'll go to a six. And before I do that, now we're in neutral rotation and I've got really good tension on the popliteus. And so I'll go ahead and put that screw down. And this is a six by 20 screw. Typically the fibular tunnel is 22mm or 25 or so. So you've got plenty of room. And there you can see we've got nice fixation. Okay. Now we're going to start to tension the LCL. So we're going to actually go to 20 degrees. And we're going to start pulling our graft in. So there's our graft and we're neutral rotation valgus and 20 degrees. Speaker  And I'm independently tensioning this because I've already secured the LCL at the level of the fibula. So the fibula is secured with the popliteus that we did at 60, and now we're at 20 degrees, and that graft is tight and we're going to just pull it in here and you can see it's slowly marching in and it's still advancing. And now I feel like we're we're really maxed out. So I just wish you could all just feel this graph because it is tight. It is really, really satisfying. So fixation is outstanding. Now at this point, we're going to go ahead and just range the knee. And you can see the graft remains tight through the entire way. Slightly loosens and flexion keep going. Do a couple more cycles. Good. And then I'm going to see if I can get a little bit more retention in here. Get a little more creep. Now we are maxed and that is incredibly tight at this point. Now we can just cut our sutures. We have demonstrated today Pushed a lot of corner reconstruction using the double knotless knee fiber tack at the Popliteus. I mean, you would not know that there isn't a socket there. I mean, it's incredible. And we've also demonstrated today the advantage of the new fiber tag tightrope two PFC with a curved needle, which allowed us to do in-situ preparation of the fiber tag, I think much easier than the than the straight needle in this particular situation. Speaker  And so using the new tensioning position coming towards us laterally, it ensures that the button stays secured on the medial cortex. And I think it worked beautifully and has the advantage of not pulling the button off of the femur. Here we're going to demonstrate the new loop link, which is a 0.9mm suture tape with a loop. And it's got a long single tail and a curved needle. What we do is we'll reach in and then we can literally put it through the loop. And now we've created a luggage tag, and now we can just do a running suture. And this is insanely fast. We're on our last throw here. So we're going to go ahead and cut one end of the loop here. And then I can come here. And now I can just go ahead and tie. The tightrope sutures. Now we can just pull those out. And then routine closure. We've taken the vessel loop around the nerve. We're going to close the biceps. Bursa. We're going to close this little fascial layer over the anterolateral fibula. And then don't forget imbricate the gastroc back up to the biceps and then routine skin closure. Thank you so much for joining us today for this wonderful new post. A little corner technique.

Reconstrucción anatómica de la esquina posterolateral y ligamentos colaterales

Fijación del injerto para el ligamento colateral

Implante TightRope II de FiberTag®

Anclaje FiberTak® para rodilla

Reparación del ligamento colateral lateral (LCL) y del ángulo posterolateral (PLC)

Posterolateral Corner Reconstruction: Knee FiberTak® Anchors and FiberTag® TightRope® II PF Implant

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