The anatomy of the ACL and its importance in ACL reconstruction

Abstract

The anterior cruciate ligament (ACL) anatomy is very significant if a reconstruction is attempted after its rupture. An anatomic study should have to address, its biomechanical properties, its kinematics, its position and anatomic correlation and its functional properties. In this review, an attempt is made to summarize the most recent and authoritative tendencies as far as the anatomy of the ACL, and its surgical application in its reconstruction are concerned. Also, it is significant to take into account the anatomy as far as the rehabilitation protocol is concerned. Separate placement in the femoral side is known to give better results from transtibial approach. The medial tibial eminence and the intermeniscal ligament may be used as landmarks to guide the correct tunnel placement in anatomic ACL reconstruction. The anatomic centrum of the ACL femoral footprint is 43 % of the proximal-to-distal length of lateral, femoral intercondylar notch wall and femoral socket radius plus 2.5 mm anterior to the posterior articular margin. Some important factors affecting the surgical outcome of ACL reconstruction include graft selection, tunnel placement, initial graft tension, graft fixation, graft tunnel motion and healing. The rehabilitation protocol should come in phases in order to increase range of motion, muscle strength and leg balance, it should protect the graft and weightbearing should come in stages. The cornerstones of such a protocol remain bracing, controlling edema, pain and range of motion. This should be useful and valuable information in achieving full range of motion and stability of the knee postoperatively. In the end, all these advancements will contribute to better patient outcome. Recommendations point toward further experimental work with in vivo and in vitro studies, in order to assist in the development of new surgical procedures that could possibly replicate more closely the natural ACL anatomy and prevent future knee pathology.

Local delivery of controlled-release simvastatin to improve the biocompatibility of polyethylene terephthalate artificial ligaments for reconstruction of the anterior cruciate ligament

“…[1][2][3][4] The ACL provides an essential mechanism for ensuring knee stability and normal knee kinematics. 5 Surgical reconstruction of the ACL is often recommended, particularly in young and active patients. Presently, the three categories of commonly used grafts in ACL reconstruction are autograft, allograft, and synthetic graft (such as artificial or xenograft).…”

The cruciate question: what are the right questions to ask when evaluating clinical outcomes from cruciate ligament surgery in the dog?

“…Did some radiographic comparisons of outcomes between TPLO and lateral suture. However, in human surgery replacement graft techniques have been and still are used all around the world, and a large amount of research has been done into this including evaluation of outcomes and the development of national knee registries [3][4][5][6] (Table 1) (Figure 1). …”

Graft tensioning in anterior cruciate ligament reconstruction

“…The ACL originates within the inter-condylar notch of the postero-medial aspect of the lateral femoral condyle and inserts at the antero-lateral aspect of the inter-condylar area on the tibia [ Figure 2-1] (Dargel et al, 2007;Markatos, Kaseta, Lallos, Korres, & Efstathopoulos, 2013;Woo et al, 2006). Enveloped by the synovium of the knee and classified as an intra-articular but extrasynovial structure (Zantop, Petersen, Sekiya, Musahl, & Fu, 2006), the ACL is vascularised via the middle genicular artery and innervated by the posterior branches of the tibial nerve (Duthon et al, 2006).…”