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The anterior cruciate ligament: a study on its bony and soft tissue anatomy using novel 3D CT technology

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study is twofold: first, to visualize both the tibial and femoral bony insertion surfaces and second, to describe the anterior cruciate ligament (ACL) geometrically, using novel 3D CT imaging. In addition, new concepts of best-fit cylinder and central axis are introduced and evaluated.

Methods

Eight unpaired knees of embalmed cadavers were used in this study. Following the dissection process, the ACL was injected with a contrast medium for CT imaging. The obtained CT images in extension, 45°, 90° and full flexion were segmented and rendered in 3D allowing morphological and morphometric analysis of the ACL. Anatomical footprint centres, femoral and tibial footprint surface area, best-fit ACL-cylinder intersection area, best-fit ACL-cylinder/footprint coverage ratio, best-fit ACL-cylinder central axis projections at the tibial and femoral footprint in the four positions were used to describe the anatomy of the ACL, based on the Bernard, Hertel and Amis grid.

Results

Based on these parameters, with the best-fit cylinder representing the bulk of the ACL, a changing fibre-recruitment pattern was seen with a moving position of the central axis from posterior to anterior on the femoral and tibial footprint, going from extension to flexion. Furthermore, the numerical data show an increase in tibial footprint coverage by the best-fit cylinder through the ACL when the knee is progressively flexed, whereas an inverse relationship was seen on the femoral side.

Conclusion

This study is the first to describe the detailed anatomy of the human ACL with respect to its course and footprints using a 3D approach. It confirms the large difference and inter-patient variability between the tibial and femoral footprint area with the former being significantly smaller. The best-fit cylinder concept illustrates the recruitment pattern of the native ACL where in extension the postero-lateral fibres are recruited and in flexion rather the antero-medial bundle, which can be valuable information in reconstructive purposes. The best-fit cylinder and central axis concept offers additional insights into the optimal tunnel placement at the tibial and femoral footprint in order to cover the largest portion of the native ACL soft tissue, aiming for optimal ACL reconstruction.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium

    Thomas Tampere, Michiel Cromheecke & Jan Victor

  2. Department of Anatomy, Ghent University, Ghent, Belgium

    Tom Van Hoof

  3. Department of Orthopaedic Surgery and Traumatology, Sint Lucas Ghent, Groenebriel 1, 9000, Ghent, Belgium

    Hans Van der Bracht

  4. Steadman Philippon Research Institute, 181W Meadow Dr, Vail, CO, 81657, USA

    Jorge Chahla

  5. Department of Orthopaedic Surgery, Monica Hospitals, Harmoniestraat 68, 2018, Antwerp, Belgium

    Peter Verdonk

  6. Faculty of Medicine, Ghent University, Ghent, Belgium

    Peter Verdonk

  7. Department of Orthopaedic Surgery, Antwerp University, Ghent, Belgium

    Peter Verdonk

Authors
  1. Thomas Tampere
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  2. Tom Van Hoof
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  3. Michiel Cromheecke
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  4. Hans Van der Bracht
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  5. Jorge Chahla
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  6. Peter Verdonk
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  7. Jan Victor
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Corresponding author

Correspondence to Thomas Tampere.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

No funding was received for this study.

Ethical approval

In these testaments is stated that the human body can be implemented in educational or research programs with no further specification. The body donation program guarantees high ethical standards during implementation of the human body in the different projects.

Informed consent

In the Ghent Anatomical Facility informed consent for anatomical study is given as people voluntary sign up for the body donation program.

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Tampere, T., Van Hoof, T., Cromheecke, M. et al. The anterior cruciate ligament: a study on its bony and soft tissue anatomy using novel 3D CT technology. Knee Surg Sports Traumatol Arthrosc 25, 236–244 (2017). https://doi.org/10.1007/s00167-016-4310-z

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  • DOI: https://doi.org/10.1007/s00167-016-4310-z

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