Arcuate fracture of the fibular head: two-tunnel surgical technique

Avulsion fractures of the fibular head, commonly manifesting as the "arcuate sign" on radiographs, are indicative of posterolateral corner (PLC) injuries of the knee and, if inadequately managed, may lead to chronic instability and degenerative joint changes. This technical note describes a novel surgical technique for the fixation of arcuate fractures following failed anchor repair. The procedure involves dual tunnel formation in the fibula and strategic FiberTape passage to achieve anatomical reduction and stable fixation of the avulsed fragment. Key advantages of this approach include a low-profile construct, reproducibility, minimized soft tissue irritation, and lower initial implant-related cost. The technique also allows for restoration of PLC integrity while minimizing the risk for failure. Challenges such as potential unequal suture tension are acknowledged but may be mitigated through meticulous surgical execution. This method represents a reliable and effective alternative for managing unstable arcuate fractures, particularly in cases involving complex PLC injury patterns. Further studies are recommended to validate long-term outcomes and optimize treatment strategies.