Table 3.

Pearls and Pitfalls of Cortical Suspensory Device Fixation of the Proximal Tibiofibular Joint

Pearls	Pitfalls
Careful dissection required to preserve common peroneal nerve, distal branches, and surrounding vasculature	Cognizant of anatomic variants with more proximal bifurcated common peroneal nerve Avoidance of the pes anserinus complex and saphenous nerve during far-cortex drilling and deployment of the far cortex button
Mobilization of nerve to allow for ease of retraction without excessive pressure	Failure to retract the common peroneal nerve or use a drill guide can result in damage adjacent structures
Drill must be angled anteriorly (approximately 30°) to reconstitute the proximal tibiofibular joint	Confirm button implant is flipped correctly through fluoroscopy
Central pin positioning in the proximodistal and anteroposterior planes of the proximal fibular metaphysis is critical to ensure anatomic and stable fixation	Eccentric drilling can result in iatrogenic failure or loss of fixation during final construct tensioning