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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-03-2009 | Knee

A systematic review of the femoral origin and tibial insertion morphology of the ACL

Authors: Sebastian Kopf, Volker Musahl, Scott Tashman, Michal Szczodry, Wei Shen, Freddie H. Fu

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2009

Abstract

Transtibial single bundle anterior cruciate ligament (ACL) reconstruction has been the gold standard for several years. This technique often fails to restore native ACL femoral origin and tibial insertion anatomy of the ACL. Recently, there is a strong trend towards a more anatomical approach in single and double bundle ACL reconstruction. Using the anatomic double bundle structure of the ACL as a principle, the entirety of both tibial insertion and femoral origin of both bundles, the posterolateral and anteromedial, may be restored. Reflected by recent publications over the past two years, there is an increasing interest in the anatomy of the ACL. In the current study, a PubMed literature search was performed looking for measurements of the ACL femoral origin and tibial insertion. These studies show a large variability in the size and the anatomy of the femoral origin and tibial ACL insertion using different methods and specimens. The diversity of reported measurements makes clinical application of these data difficult at best. Thus, it is of paramount importance to understand the individual variations in size and shape of the ACL femoral origin and tibial ACL insertion. This study is a systematic review of the morphology of the ACL femoral origin and tibial insertion as reported in the literature.

Amis AA, Dawkins GP (1991) Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. J Bone Joint Surg Br 73:260–267PubMed

Arnoczky SP (1983) Anatomy of the anterior cruciate ligament. Clin Orthop Relat Res 45:19–25

Biau DJ, Tournoux C, Katsahian S et al (2006) Bone–patellar tendon–bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis. BMJ 332:995–1001PubMedCrossRef

Biau DJ, Tournoux C, Katsahian S et al (2007) ACL reconstruction: a meta-analysis of functional scores. Clin Orthop Relat Res 458:180–187PubMed

Chouliaras P, Paessler H (2007) The history of the anterior cruciate ligament from Galen to double-bundle ACL reconstruction. Acta Orthop Traum Hellenica 12:127–131

Colombet P, Robinson J, Christel P et al (2006) Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy 22:984–992PubMed

Cuomo P, Edwards A, Giron F et al (2006) Validation of the 65 degrees Howell guide for anterior cruciate ligament reconstruction. Arthroscopy 22:70–75PubMed

Dargel J, Pohl P, Tzikaras P et al (2006) Morphometric side-to-side differences in human cruciate ligament insertions. Surg Radiol Anat 28:398–402PubMedCrossRef

Dienst M, Burks RT, Greis PE (2002) Anatomy and biomechanics of the anterior cruciate ligament. Orthop Clin North Am 33:605–620PubMedCrossRef

10.

Edwards A, Bull AM, Amis AA (2007) The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament: Part 1: tibial attachment. Knee Surg Sports Traumatol Arthrosc 15:1414–1421PubMedCrossRef

11.

Edwards A, Bull AM, Amis AA (2008) The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament: Part 2: femoral attachment. Knee Surg Sports Traumatol Arthrosc 16:29–36PubMedCrossRef

12.

Ferretti M, Ekdahl M, Shen W et al (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23:1218–1225PubMed

13.

Fithian DC, Paxton EW, Stone ML et al (2005) Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee. Am J Sports Med 33:335–346PubMedCrossRef

14.

Freedman KB, D’Amato MJ, Nedeff DD et al (2003) Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31:2–11PubMed

15.

Fu FH, Shen W, Starman JS et al (2008) Primary anatomic double-bundle anterior cruciate ligament reconstruction: a preliminary 2-year prospective Study. Am J Sports Med. Epub ahead of print

16.

Gabriel MT, Wong EK, Woo SL et al (2004) Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads. J Orthop Res 22:85–89PubMedCrossRef

17.

Girgis FG, Marshall JL, Monajem A (1975) The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res 106:216–231PubMedCrossRef

18.

Harner CD, Baek GH, Vogrin TM et al (1999) Quantitative analysis of human cruciate ligament insertions. Arthroscopy 15:741–749PubMed

19.

Harner CD, Livesay GA, Kashiwaguchi S et al (1995) Comparative study of the size and shape of human anterior and posterior cruciate ligaments. J Orthop Res 13:429–434PubMedCrossRef

20.

Heming JF, Rand J, Steiner ME (2007) Anatomical limitations of transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med 35:1708–1715PubMedCrossRef

21.

Järvelä T, Moisala AS, Sihvonen R et al (2008) Double-bundle anterior cruciate ligament reconstruction using hamstring autografts and bioabsorbable interference screw fixation: prospective, randomized, clinical study with 2-year results. Am J Sports Med 36:290–297PubMedCrossRef

22.

Kannus P, Järvinen M (1987) Long-term prognosis of non-operatively treated acute knee distortions having primary hemarthrosis without clinical instability. Am J Sports Med 15:138–143PubMedCrossRef

23.

Kennedy JC, Weinberg HW, Wilson AS (1974) The anatomy and function of the anterior cruciate ligament. As determined by clinical and morphological studies. J Bone Joint Surg Am 56:223–235PubMed

24.

Lee GC, Cushner FD, Vigoritta V et al (2005) Evaluation of the anterior cruciate ligament integrity and degenerative arthritic patterns in patients undergoing total knee arthroplasty. J Arthroplasty 20:59–65PubMedCrossRef

25.

Lohmander LS, Östenberg A, Englund M et al (2004) High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 50:3145–3152PubMedCrossRef

26.

Luites JW, Wymenga AB, Blankevoort L et al (2007) Description of the attachment geometry of the anteromedial and posterolateral bundles of the ACL from arthroscopic perspective for anatomical tunnel placement. Knee Surg Sports Traumatol Arthrosc 15:1422–1431PubMedCrossRef

27.

McDaniel WJ, Dameron TB (1983) The untreated anterior cruciate ligament rupture. Clin Orthop Relat Res 172:158–163PubMed

28.

Mochizuki T, Muneta T, Nagase T et al (2006) Cadaveric knee observation study for describing anatomic femoral tunnel placement for two-bundle anterior cruciate ligament reconstruction. Arthroscopy 22:356–361PubMed

29.

Morgan CD, Kalman VR, Grawl DM (1995) Definitive landmarks for reproducible tibial tunnel placement in anterior cruciate ligament reconstruction. Arthroscopy 11:275–288PubMed

30.

Mullaji AB, Marawar SV, Simha M et al (2008) Cruciate ligaments in arthritic knees; a histologic study with radiologic correlation. J Arthroplasty 23:567–572PubMedCrossRef

31.

Muneta T, Takakuda K, Yamamoto H (1997) Intercondylar notch width and its relation to the configuration and cross-sectional area of the anterior cruciate ligament. A cadaveric knee study. Am J Sports Med 25:69–72PubMedCrossRef

32.

Neyret P, Donell ST, Dejour H (1993) Results of partial meniscectomy related to the state of the anterior cruciate ligament. Review at 20 to 35 years. J Bone Joint Surg Br 75:36–40PubMed

33.

Noyes FR, Mooar PA, Matthews DS et al (1983) The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. J Bone Joint Surg Am 65:154–162PubMed

34.

Odensten M, Gillquist J (1985) Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg Am 67:257–262PubMed

35.

Petersen W, Tretow H, Weimann A et al (2007) Biomechanical evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction: one tibial tunnel versus two tibial tunnels. Am J Sports Med 35:228–234PubMedCrossRef

36.

Sakane M, Fox RJ, Woo SL et al (1997) In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res 15:285–293PubMedCrossRef

37.

Siebold R, Dehler C, Ellert T (2008) Prospective randomized comparison of double-bundle versus single-bundle anterior cruciate ligament reconstruction. Arthroscopy 24:137–145PubMedCrossRef

38.

Siebold R, Ellert T, Metz S et al (2008) Femoral insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry and arthroscopic orientation models for double-bundle bone tunnel placement—a cadaver study. Arthroscopy 24:585–592PubMedCrossRef

39.

Siebold R, Ellert T, Metz S et al (2008) Tibial insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry, arthroscopic landmarks, and orientation model for bone tunnel placement. Arthroscopy 24:154–161PubMedCrossRef

40.

Sommerlath K, Lysholm J, Gillquist J (1991) The long-term course after treatment of acute anterior cruciate ligament ruptures. A 9-to–16 year follow-up. Am J Sports Med 19:156–162PubMedCrossRef

41.

Stäubli HU, Rauschning W (1994) Tibial attachment area of the anterior cruciate ligament in the extended knee position. Anatomy and cryosections in vitro complemented by magnetic resonance arthrography in vivo. Knee Surg Sports Traumatol Arthrosc 2:138–146PubMedCrossRef

42.

Takahashi M, Doi M, Abe M et al (2006) Anatomical study of the femoral and tibial insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament. Am J Sports Med 34:787–792PubMedCrossRef

43.

Tashman S, Collon D, Anderson K et al (2004) Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med 32:975–983PubMedCrossRef

44.

Tállay A, Lim MH, Bartlett J (2008) Anatomical study of the human anterior cruciate ligament stump’s tibial insertion footprint. Knee Surg Sports Traumatol Arthrosc 16:741–746PubMedCrossRef

45.

Tsukada H, Ishibashi Y, Tsuda E et al (2008) Anatomical analysis of the anterior cruciate ligament femoral and tibial footprints. J Orthop Sci 13:122–129PubMedCrossRef

46.

Weber WE, Weber EFW (1836) Mechanik der menschlichen Gehwerkzeuge: eine anatomisch-physiologische Untersuchung. Dietrische Buchhandlung, Göttingen

47.

Yagi M, Wong EK, Kanamori A et al (2002) Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30:660–666PubMed

48.

Yasuda K, Kondo E, Ichiyama H et al (2006) Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy 22:240–251PubMedCrossRef

49.

Zantop T, Herbort M, Raschke MJ et al (2007) The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation. Am J Sports Med 35:223–227PubMedCrossRef

50.

Zantop T, Petersen W, Sekiya JK et al (2006) Anterior cruciate ligament anatomy and function relating to anatomical reconstruction. Knee Surg Sports Traumatol Arthrosc 14:982–992PubMedCrossRef

51.

Zantop T, Wellmann M, Fu FH et al (2008) Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med 36:65–72PubMedCrossRef

Title: A systematic review of the femoral origin and tibial insertion morphology of the ACL
Authors: Sebastian Kopf
Volker Musahl
Scott Tashman
Michal Szczodry
Wei Shen
Freddie H. Fu
Publication date: 01-03-2009
Publisher: Springer-Verlag
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2009
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-008-0709-5

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A systematic review of the femoral origin and tibial insertion morphology of the ACL

Abstract

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