Anatomical study of the human anterior cruciate ligament stump’s tibial insertion footprint

Abstract

The aim of this study is to define the topographical relationship of the anatomical bundles of the human anterior cruciate ligament's (ACL) stump over the tibial insertion site. Between January and April 2007, a total of 36 resected tibial plateaus were retrieved from patients who underwent total knee replacements. These samples had intact cruciate ligaments with no major osteophyte around the ACL tibial insertion footprint. The anatomical bundles of the ACL were identified and mapped, based on the topographical relationship over the tibial insertion footprint. Measurements of the dimensions of the ACL tibial footprint and tibial plateau were performed. The mean width and midsagittal depth of the tibia plateau was 78.7 +/- 6.5 and 46.4 +/- 5.0 mm, respectively. The mean width and midsagittal depth of the ACL tibial footprint was 10.3 +/- 1.9 and 19.5 +/- 2.6 mm, respectively. Out of the 36 freshly dissected ACL stumps, it was not possible to distinguish separate bundles in 14 (38.9%) cases. The average distance between the centers of the two bundles was 9.3 +/- 1.8 mm. The mean AP alignment of the tibial footprint was 89.6 degrees +/- 26.4 degrees , with a very wide range of 23 degrees -158 degrees . Of the 22 specimens with separate anatomical bundles, the alignment of the tibial footprint was AM-PL in six (27.3%), sagittal (85 degrees -95 degrees ) in five (22.7), AL-PM in nine (40.9%), and lateral-medial (L-M) in two (9.1%) cases. This study provides new information about the topographical anatomy of the ACL tibial insertion footprint. Based on gross anatomy, separate anatomical bundles of the ACL can be distinguished in 61.1% [22] of the specimens. The topographical alignment of the separate bundles is varied on a very wide range.

Tibial Landmarks in Acl Anatomic Repair

“…Изучив анатомию плато большеберцовой кос ти на 36 препаратах А. Tallay с соавтора-ми пришли к выводу, что в 77,8% случаев ме-сто прикрепления имеет вид овала и в 22,8% -вид треугольника [22].…”

The Morphometry of Soft Tissue Insertions on the Tibial Plateau: Data Acquisition and Statistical Shape Analysis

“…A few observational studies have described the locations of the meniscal root attachments in relation to bony or soft tissue landmarks [31]–[33], but the location measures were not scaled or normalized by any tibial measure to elicit potential invariant or common morphological features. The shape variability of cruciate ligament insertions has been documented largely by qualitative descriptions [28], [29], [34], [35]. The ACL tibial insertion sites were found to be triangular or oval in most specimens in some studies [22], [36], and to be more variable than that of the femoral attachments in others [24], [28], [34].…”

“…The shape variability of cruciate ligament insertions has been documented largely by qualitative descriptions [28], [29], [34], [35]. The ACL tibial insertion sites were found to be triangular or oval in most specimens in some studies [22], [36], and to be more variable than that of the femoral attachments in others [24], [28], [34]. The tibial PCL insertion site was described as trapezoidal in one study [35], but more various gross appearances were noted in other studies [29], [37].…”

Synovial C-Shaped Tibial Footprint of the Anterior Cruciate Ligament

“…5,11 Although numerous anatomic studies about the ACL structure and attachments have been performed, these studies have not reached consensus regarding the ACL footprint. 7,23,25,29 …”

“…1–3,12,18,22,24 However, histological studies remain controversial: Some find no evidence of different anatomic subdivisions of the ACL, whereas others show a well-defined septum dividing the AM and PL bundles. 4,9,21,25,28 …”