Abstract
BACKGROUND: Current literature describes several surgical techniques for posterolateral corner (PLC) reconstruction, but lacks a comprehensive analysis of the Arciero technique. The clinical efficacy of this dual femoral tunnel, fibular-based technique remains unevaluated. METHODS: A systematic literature search of PubMed and Scopus identified published studies reporting clinical outcomes following a dual femoral tunnel, fibular-based PLC reconstruction. Inclusion criteria were outcome studies of surgical PLC reconstruction utilizing either the Arciero technique or a modification of it, specifically with two femoral and one fibular fixation point. Articles were assessed for level of evidence and methodology using the Modified Coleman Methodology Score (MCMS). Demographics, clinical outcomes (Lysholm, subjective and objective IKDC, Tegner), biomechanical joint stability (varus stress test, dial test, varus radiography), complications and failures were recorded. Standardized mean differences were used to estimate the overall effect size between pre- and post-operative scores. PROSPERO 2025 CRD420251045883. RESULTS: Eight studies (203 patients) met inclusion criteria. Ages ranged 16-61 years and follow-up ranged 1-10 years. Lysholm and Tegner scores indicated favorable outcomes. The weighted average IKDC score was 76.88. Post-operative objective clinical outcome evaluations showed 77.8 % of IKDC scores were grade A or B, a 0.6 mm side-to-side difference on varus radiography, normal varus stress tests in 81 % of patients, and a negative dial test in 75 % of patients. Five complications (2.5 %) were reported with no failures requiring revision. The mean MCMS was 56 (range 50-63). CONCLUSION: The fibular-based dual femoral tunnel (Arciero) technique for PLC reconstruction results in strong clinical outcomes. Surgeons should select a PLC reconstruction method tailored to their experience, training, and specific patient needs, considering the Arciero technique when the difficulties associated with a more technically demanding procedure or the risks of knee over-constraint outweigh the potential benefits of more anatomic combined tibia and fibula-based reconstructions.