Description of the attachment geometry of the anteromedial and posterolateral bundles of the ACL from arthroscopic perspective for anatomical tunnel placement

Abstract

The anterior cruciate ligament (ACL) consists of an anteromedial bundle (AMB) and a posterolateral bundle (PLB). A reconstruction restoring the functional two-bundled nature should be able to approximate normal ACL function better than the most commonly used singlebundle reconstructions. Accurate tunnel positioning is important, but difficult. The purpose of this study was to provide a geometric description of the centre of the attachments relative to arthroscopically visible landmarks. The AMB and PLB attachment sites in 35 dissected cadaver knees were measured with a 3D system, as were anatomical landmarks of femur and tibia. At the femur, the mean ACL centre is positioned 7.9 ± 1.4 mm (mean ± 1 SD) shallow, along the notch roof, from the most lateral over-the-top position at the posterior edge of the intercondylar notch and from that point 4.0 ± 1.3 mm from the notch roof, low on the surface of the lateral condyle wall.The mean AMB centre is at 7.2 ± 1.8 and 1.4 ± 1.7 mm, and the mean PLB centre at 8.8 ± 1.6 and 6.7 ± 2.0 mm. At the tibia, the mean ACL centre is positioned 5.1 ± 1.7 mm lateral of the medial tibial spine and from that point 9.8 ± 2.1 mm anterior. The mean AMB centre is at 3.0 ± 1.6 and 9.4 ± 2.2 mm, and the mean PLB centre at 7.2 ± 1.8 and 10.1 ± 2.1 mm. The ACL attachment geometry is well defined relative to arthroscopically visible landmarks with respect to the AMB and PLB. With simple guidelines for the surgeon, the attachments centres can be found during arthroscopic single-bundle or double-bundle reconstructions.

Methodology of Knee Bones Models 3D Printing Based on CT Series of Images

“…Average measured tibial ACL insertion site area measured at 46 patients according to [2] was 114 mm 2 , and can vary from 67-259 mm 2 . Luites et al [3] measured this area at 35 cadaveric knees and it was 229±53 mm 2 . In a study [2] average measured femoral ACL insertion site measured at 50 patients was 83 mm 2 and can vary from 46-156 mm 2 .…”

Development of a femoral template for computer-assisted tunnel placement in anatomical double-bundle ACL reconstruction

“…Thirtythree human cadaver femoral bones were used for this phase. These femora were previously dissected for an anatomical study of the insertion site of the two bundles of the ACL [23]. The bones were preserved in formalin, and no exact data on the gender and age of the donors was available.…”

“…Basic anatomical studies have improved the description and understanding of the position of the ACL and its two bundles in the femoral notch [22][23][24][25][26][27][28][29]. Studies to develop improved methods for accurate femoral tunnel positioning and drilling have encompassed radiographic guidelines [16,30], tensiometers and femoral aiming guides [31,32], computer-assisted fluoroscopic navigation [33][34][35], computer-assisted real-time navigation [36][37][38][39][40][41] and robotic-assisted surgery systems [42,43].…”

“…This approach could also be applied to ACL surgery, standardizing the positions of the insertion centers of the AM and PL bundles. In a previous study [23], we determined the insertion centers of the anteromedial and posterolateral bundles of the ACL in cadaver knees. The purpose of the current study was to generate a standardized template, incorporated in a CAS system, by quantifying the femoral insertion centers of the AM and PL bundles in the notch.…”

Double-bundle Anterior Cruciate Ligament reconstruction: a review of literature

“…Regardless of the surgical intervention method used, the key element in ACL surgery remains knee and ACL anatomy, which have been resolved thoroughly for the tibial and femoral sides [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The ACL has two bundles, anteromedial and posterolateral, the names given from the tibial insertion site.…”