Restoration of the tibial ACL footprint area and geometry using the Modified Insertion Site Table

Siebold, Rainer; Schuhmacher, Peter

doi:10.1007/s00167-012-1899-4

Cited by 24 publications

(19 citation statements)

References 23 publications

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“…Most authors described the tibial ACL insertion to be oval, with the insertion of the anteromedial (AM) bundle in the AM aspect with direct relation to the medial tibial spine. The insertion of the posterolateral (PL) bundle was reported to be in the PL aspect of the ACL footprint close to the lateral tibial spine in front of the posterior root of the lateral meniscus [ 7 , 11 , 17 , 28 , 30 , 32 , 33 ]. Most anatomical studies were performed using paraffined specimen.…”

Section: Introductionmentioning

confidence: 99%

Flat midsubstance of the anterior cruciate ligament with tibial “C”-shaped insertion site

Siebold

Schuhmacher²,

Fernandez³

et al. 2014

Knee Surg Sports Traumatol Arthrosc

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163

172

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Purpose This anatomical cadaver study was performed to investigate the flat appearance of the midsubstance shape of the anterior cruciate ligament (ACL) and its tibial “C”-shaped insertion site.MethodsThe ACL midsubstance and the tibial ACL insertion were dissected in 20 cadaveric knees (n = 6 fresh frozen and n = 14 paraffined). Magnifying spectacles were used for all dissections. Morphometric measurements were performed using callipers and on digital photographs.ResultsIn all specimens, the midsubstance of the ACL was flat with a mean width of 9.9 mm, thickness of 3.9 mm and cross-sectional area of 38.7 mm2. The “direct” “C”-shaped tibial insertion runs from along the medial tibial spine to the anterior aspect of the lateral meniscus. The mean width (length) of the “C” was 12.6 mm, its thickness 3.3 mm and area 31.4 mm2. The centre of the “C” was the bony insertion of the anterior root of the lateral meniscus overlayed by fat and crossed by the ACL. No posterolateral (PL) inserting ACL fibres were found. Together with the larger “indirect” part (area 79.6 mm2), the “direct” one formed a “duck-foot”-shaped footprint.ConclusionThe tibial ACL midsubstance and tibial “C”-shaped insertion are flat and are resembling a “ribbon”. The centre of the “C” is the bony insertion of the anterior root of the lateral meniscus. There are no central or PL inserting ACL fibres. Anatomical ACL reconstruction may therefore require a flat graft and a “C”-shaped tibial footprint reconstruction with an anteromedial bone tunnel for single bundle and an additional posteromedial bone tunnel for double bundle.

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Section: Introductionmentioning

confidence: 99%

Flat midsubstance of the anterior cruciate ligament with tibial “C”-shaped insertion site

Siebold

Schuhmacher²,

Fernandez³

et al. 2014

Knee Surg Sports Traumatol Arthrosc

Self Cite

163

172

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“…The ribbon-like shape of the ACL and the flat but long femoral “direct” insertion site would support a rather flat anatomical footprint and midsubstance reconstruction. A double bundle ACL reconstruction using two 5–6 mm hamstring grafts [ 25 , 31 , 32 , 42 , 44 , 46 ], a flat 5–6 mm patella tendon graft [ 43 ] or a flat 5–6 mm quadriceps tendon graft may be a better anatomical option than a large (and too wide) diameter graft for a single-bundle ACL reconstruction. Sasaki et al [ 42 ] concluded that whereas the indirect insertion plays a role as a dynamic anchorage of soft tissue to bone allowing certain shear movements, the strength of anchoring is weaker than the direct insertion [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

Ribbon like appearance of the midsubstance fibres of the anterior cruciate ligament close to its femoral insertion site: a cadaveric study including 111 knees

Śmigıelski¹,

Zdanowicz²,

Drwięga³

et al. 2014

Knee Surg Sports Traumatol Arthrosc

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203

146

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Purpose Recently, the configuration of the anterior cruciate ligament (ACL) from its direct femoral insertion to midsubstance was found to be flat. This might have an important impact for anatomical ACL reconstruction. The purpose of this anatomical study was to evaluate the macroscopic appearance of the ACL from femoral to midsubstance.MethodsThe ACL was dissected in 111 human fresh frozen cadaver knees from its femoral insertion to midsubstance, and the shape was described. The anatomical findings were documented on digital photographs and on video. Thirty knees were sent for computed tomography (CT), magnetic resonance imaging (MRI) and histology of the femoral ACL insertion.ResultsTwo millimetres from its direct femoral insertion, the ACL fibres formed a flat ribbon in all dissected knees without a clear separation between AM and PL bundles. The ribbon was in exact continuity of the posterior femoral cortex. The width of the ribbon was between 11.43 and 16.18 mm and the thickness of the ACL was only 2.54–3.38 mm. 3D CT, MRI and the histological examination confirmed above findings.ConclusionThis is a detailed anatomical study describing the ribbon-like structure of the ACL from its femoral insertion to midsubstance. A key point was to carefully remove the surface fibrous membrane of the ACL. A total of 2–3 mm from its bony femoral insertion, the ACL formed a flat ribbon without a clear separation between AM and PL bundles. The ribbon was in exact continuity of the posterior femoral cortex. The findings of a flat ligament may change the future approach to femoral ACL footprint and midsubstance ACL reconstruction and to graft selection.Electronic supplementary materialThe online version of this article (doi:10.1007/s00167-014-3146-7) contains supplementary material, which is available to authorized users.

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“…Frobell et al introduced "treatment failures" as a group of patients with a "severely decreased knee-related quality of life". 45 To be within this category the patients had to meet the three criteria: A KOOS QoL subscore less than 44 points, a history of "giving-way" episodes and a positive pivot shift at examination. 45 Later studies revealed that patients with a KOOS QoL subscore less than 44 points are associated with having a 3.7 times higher risk of later revision surgery.…”

Section: Treatment Failurementioning

confidence: 99%

No Difference in the KOOS Quality of Life Subscore Between Anatomic Double-Bundle and Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction of the Knee: A Prospective Randomized Controlled Trial With 2 Years’ Follow-up

et al. 2018

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Restoration of the tibial ACL footprint area and geometry using the Modified Insertion Site Table

Cited by 24 publications

References 23 publications

Flat midsubstance of the anterior cruciate ligament with tibial “C”-shaped insertion site

Flat midsubstance of the anterior cruciate ligament with tibial “C”-shaped insertion site

Ribbon like appearance of the midsubstance fibres of the anterior cruciate ligament close to its femoral insertion site: a cadaveric study including 111 knees

No Difference in the KOOS Quality of Life Subscore Between Anatomic Double-Bundle and Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction of the Knee: A Prospective Randomized Controlled Trial With 2 Years’ Follow-up

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