Anterior Cruciate Ligament Insertions on the Tibia and Femur and Their Relationships to Critical Bony Landmarks Using High-Resolution Volume-Rendering Computed Tomography

Purnell, Mark L.; Larson, Andrew I.; Clancy, William G.

doi:10.1177/0363546508319896

Cited by 252 publications

(219 citation statements)

References 16 publications

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“…In this descriptive laboratory study ACL fibres were present up to the roof of the notch and to within 3 to 3.5 mm of the articular surface posteriorly and inferiorly [20].…”

Section: Anatomymentioning

confidence: 82%

Anatomical single bundle anterior cruciate ligament reconstruction

Carmont

Scheffler

Spalding

et al. 2011

Curr Rev Musculoskelet Med

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“…In this descriptive laboratory study ACL fibres were present up to the roof of the notch and to within 3 to 3.5 mm of the articular surface posteriorly and inferiorly [20].…”

Section: Anatomymentioning

confidence: 82%

Anatomical single bundle anterior cruciate ligament reconstruction

Carmont

Scheffler

Spalding

et al. 2011

Curr Rev Musculoskelet Med

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“…In 80 % of all cases, a second ridge, the bifurcate ridge, can also be identified. This ridge separates the origins of the AM and PL bundle and runs perpendicular to the intercondylar ridge [17,18] (Fig. 2).…”

Section: The Double-bundle Conceptmentioning

confidence: 97%

Indications and contraindications for double-bundle ACL reconstruction

Muller

Hofbauer

Wongcharoenwatana

et al. 2012

International Orthopaedics (SICOT)

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Over recent years, double-bundle reconstruction has gained popularity after studies showed significant advantages of adding a second bundle with regard to outcomes and biomechanics; in particular, it resulted in less rotational instability than after reconstruction with a traditional single-bundle technique. As the focus shifted further towards the restoration of the native anatomy, both single-bundle and double-bundle ACL reconstruction were performed in an anatomical fashion and yielded similar results. To date, no consensus has developed as to whether double-bundle reconstruction is better than single-bundle reconstruction or vice versa. However, after surgeons started to individualise their surgical approach to the patient, it has been found that both the anatomical single-and double-bundle techniques have their own set of indications and contraindications. Reconstruction of the ligament should focus on restoration of the native functional and anatomical properties and should take the size, shape and orientation of the ACL into account. When indications and contraindications for the technique used are based on native anatomical characteristics, either a single-bundle or a doublebundle procedure can be performed according to the same double-bundle concept.

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“…Numerous authors have highlighted the clinical value of 3D-CT for the assessment of tunnel position after ACL reconstruction [7][8][9][10][11][12]. Thus, 3D reconstructed CT images are increasingly used to investigate the femoral and tibial tunnel position after ACL reconstruction [7-9, 11, 12].…”

Section: Introductionmentioning

confidence: 99%

SPECT/CT tracer uptake is influenced by tunnel orientation and position of the femoral and tibial ACL graft insertion site

Hirschmann

Mathis

Rasch

et al. 2012

International Orthopaedics (SICOT)

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Purpose SPECT/CT is a hybrid imaging modality, which combines a 3D scintigraphy (SPECT) and a conventional computerised tomography (CT). SPECT/CT allows accurate anatomical localisation of metabolic tracer activity. It allows the correlation of surgical factors such as tunnel position and orientation with mechanical alignment, clinical outcome and biological factors. The purpose of this study was to investigate whether the SPECT/CT tracer uptake (intensity and distribution) correlates with the stability and laxity of the knee joint and the position and orientation of the tibial and femoral tunnels in patients after anterior cruciate ligament (ACL) reconstruction. Methods A consecutive series of knees (n066), with symptoms of pain and/or instability after ACL reconstruction were prospectively evaluated using clinical examination and 99mTc-HDP-SPECT/CT. Clinical laxity testing was performed using the Rolimeter (Ormed, Freiburg, Germany) including Lachman testing (0-2 mm, 3-5 mm, 6-10 mm, >10 mm), anterior drawer test (0-2 mm, 3-5 mm, 6-10 mm, >10 mm), pivot shift test (positive versus negative) and patientbased subjective instability (yes versus no).For analysis of SPECT/CT tracer uptake a previously validated SPECT/CT localisation scheme consisting of 17 tibial, nine femoral and four patellar regions on standardised axial, coronal, and sagittal slices was used. The tracer activity on SPECT/CT was localised and recorded using a 3D volumetric and quantitative analysis software.Mean, standard deviation, minimum and maximum of grading for each area of the localisation scheme were recorded. The position and orientation of the tibial and femoral tunnel was assessed using a previously published method on 3D-CT. Results Correlation of instability, pivot shift as well as clinical laxity testing with 99mTc-HDP-SPECT/CT tracer uptake intensity and distribution showed no significant correlation. 99mTc-HDP-SPECT/CT tracer uptake correlated significantly with the position and orientation of the ACL graft. A more horizontal femoral graft position showed significantly increased tracer uptake within the superior and posterior femoral regions. A more posteriorly-placed femoral insertion site showed significantly more tracer uptake within the femoral and tibial tunnel regions. A more vertical or a less medial tibial tunnel orientation showed significant increased uptake within the tibial and femoral tunnel regions. A more anterior tibial tunnel position showed significantly more tracer uptake in the femoral and tibial tunnel regions as well as the entire tibiofemoral joint. Conclusions SPECT/CT tracer uptake intensity and distribution showed a significant correlation with the femoral and tibial tunnel position and orientation in patients with symptomatic knees after ACL reconstruction. No correlation was found with stability or clinical laxity.Michael T. Hirschmann and Dominic Mathis contributed equally to this paper.

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Anterior Cruciate Ligament Insertions on the Tibia and Femur and Their Relationships to Critical Bony Landmarks Using High-Resolution Volume-Rendering Computed Tomography

Abstract: Bony landmarks can be used to aid in anatomical anterior cruciate ligament reconstruction.

Cited by 252 publications

References 16 publications

Anatomical single bundle anterior cruciate ligament reconstruction

Anatomical single bundle anterior cruciate ligament reconstruction

Indications and contraindications for double-bundle ACL reconstruction

SPECT/CT tracer uptake is influenced by tunnel orientation and position of the femoral and tibial ACL graft insertion site

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