The angle of inclination of the native ACL in the coronal and sagittal planes

Reid, Jonathan C.; Yonke, Bret; Tompkins, Marc

doi:10.1007/s00167-017-4419-8

Cited by 31 publications

(28 citation statements)

References 22 publications

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“…In spite of having a significant difference between the coronal GIA in the AAMPT group (mean of 28.8±3.4°) and the MTTT group (mean of 23.76±5.64°), both the techniques place the graft in more inclination than native ACL which was found to be 15.72±4.75°. 29 MTTT in this study had GIA of 23.76° which is higher than the angle of the traditional TTT 5 , 21 , 30 , 31 and lies in-between the other modified TTT studies 22 , 32 , 38 (values presented in the literature, Figure 16 ).…”

Section: Discussioncontrasting

confidence: 41%

Modified transtibial versus anteromedial portal techniques for anterior cruciate ligament reconstruction, a comparative study

Hussin

Aldaheri

Al-Harbi

et al. 2018

OAJSM

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PurposeThis study compared the accessory anteromedial portal (AAMP) and the modified transtibial technique (MTTT)” for single-bundle anterior cruciate ligament (ACL) reconstruction.Patients and methodsSixty active adult patients with ACL tear were randomly assigned into two equal groups who were treated surgically. One group was operated on using AAMP and the other group through MTTT. Both the groups had the same postoperative course and were followed for 1 year after surgery. The follow-up included Lysholm and International Knee Documentation Committee (IKDC) subjective knee evaluation forms, IKDC objective knee examination form, and radiological evaluation. Results were evaluated and compared with each other.ResultsThere was no significant difference in subjective effects or clinical examination between the two groups. Regarding radiological angles, the AAMP had more oblique graft orientation in the coronal plane than the MTTT, but both were found to be more slanted than native ACL. Also, the MTTT had succeeded to place the graft and tunnel more obliquity than the traditional non-anatomic TTT and better than the anatomic ranges despite having the graft inclination of the AAMP higher than the MTTT. The complaints from the patients and subjective scoring were found to be positively related to graft stability. Patients with healthier preoperative subjective state had a smoother postoperative period and better outcome.ConclusionThis study offers simple modifications to the transtibial technique to allow near anatomic ACL reconstruction with similar results comparable to the AAMP and with fewer complications.

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Section: Discussioncontrasting

confidence: 41%

Modified transtibial versus anteromedial portal techniques for anterior cruciate ligament reconstruction, a comparative study

Hussin

Aldaheri

Al-Harbi

et al. 2018

OAJSM

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“…Results showed an overall mean coronal angle of inclination of 63.4°, with the larger angle measuring 65.9° and the smaller angle measuring 60.7°. The overall ACL coronal angle average established in this study was slightly smaller than previously published coronal angles ranging from 65° to 76° (Ahn et al, 2016; Gentili et al, ; Illingworth et al, ; Kim et al, ; Reid et al, ). The ACL angle differences may be because of the variations in measurement techniques such as manual versus MRI studies, degree of knee flexion, or sample characteristics such as sex.…”

Section: Discussioncontrasting

confidence: 75%

“…One limitation of this study was the age of the cadavers (mean 76.5 ± 11.5 years), as the majority of ACL injuries occur to teenagers and young adults. Previous studies demonstrated differences in the coronal angle of inclination between skeletally immature and mature individuals (Kim et al, ; Reid et al, ). This variable was eliminated as only skeletally mature individuals were utilized.…”

Section: Discussionmentioning

confidence: 92%

Side Variations of Anterior Cruciate Ligament Coronal Angles: Implications for ACL Reconstruction

et al. 2019

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Current literature has shown a biomechanical advantage of recreating the native coronal obliquity of the anterior cruciate ligament (ACL) during grating procedures; however, the majority of studies on ACL morphological variation have been performed unilaterally. This cadaveric study aimed to evaluate sided ACL coronal angle of inclination variation including trend analysis with sex, age, height, and femoral condyle width. The ACLs of 57 embalmed cadaveric specimens were evaluated bilaterally for a total of 114 ACLs. The knees were flexed to 110 . A 0.70-mm wire measured coronal angulation through the lateral tibial plateau and the medial ACL border. An image taken of the wire allowed digital measurement with the ImageJ software. IBM SPSS was utilized for statistical analysis. Bilateral measurements demonstrated a difference in an individual's sided ACL angulation (P < 0.001). Right-sided angulation was greater in 61.4% (35/57). In cadavers with greater right-side angulation, right ACLs averaged 66.2 versus left ACLs averaged 60.9 (P < 0.001). Cadavers with greater leftsided ACL angles demonstrated average left ACLs measuring 65.5 versus right ACLs measuring 60.6 (P < 0.001). Right-sided angles were greater in 69.7% of females. Understanding the anatomy of the ACL's native coronal angle and variations between a patient's knees is imperative during reconstruction surgery to aid in anatomic tunnel placement for improved knee motion and rotational knee kinematics following surgery. A statistically significant difference exists between an individual's right and left ACL coronal angles of inclination.

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“…Such information will also help to improve surgical treatments (eg, more accurate graft sizing and tunnel positioning) or to develop more relevant computer models for studying ACL biomechanics. This has motivated numerous investigations to study the age-related [21][22][23] or sex-dependent 24,25 differences in ACL morphology. A recent comprehensive review by Cone et al, 26 has provided summaries of the existing reports on a range of morphological features of the ACL.…”

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confidence: 99%

Age‐related changes in ACL morphology during skeletal growth and maturation are different between females and males

Hosseinzadeh

Kiapour

2020

Journal Orthopaedic Research

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Despite a well-established role of anterior cruciate ligament (ACL) anatomy on its biomechanics, little is known on how ACL anatomy develops and changes during skeletal growth. We hypothesized that ACL size and orientation will change by age during skeletal growth and maturation with different trends in males vs females. Magnetic resonance images of 269 unique knees (3-18 years old; 51% female) were used to measure ACL length, cross-sectional area, length-to-cross-sectional area ratio, and elevation angles. In both males and females, ACLs became longer, thicker, and more vertical in sagittal and coronal planes by increasing age (R 2 > 0.2; P < .001 for all associations). ACL cross-sectional area-to-length ratio increased by age only in males (R 2 = 0.06; P = .003). Despite similar ACL sizes between males and females at early age, adolescent males had significantly longer and thicker ACLs compared to the age-matched females (P < .05). There were no sex differences in ACL elevation angles (P > .2) except for larger coronal elevation in 7 to 10 years old females compared to age-matched males (P = .012). Observed changes in ACL cross-sectional area-to-length ratio indicate that age-and sex-dependent changes in ACL size are not homogenous. The trends seen in normalized ACL size measurements suggest that unlike ACL cross-sectional area, ACL length is primarily controlled by body size. Smaller ACLs and lower cross-sectional growth rates observed in females may be contributing factors to the higher risk of ACL injuries in females. Further investigations are required to identify the intrinsic and extrinsic factors responsible for these discrepancies.

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The angle of inclination of the native ACL in the coronal and sagittal planes

Abstract: Prognostic retrospective study, Level of evidence III.

Cited by 31 publications

References 22 publications

Modified transtibial versus anteromedial portal techniques for anterior cruciate ligament reconstruction, a comparative study

Modified transtibial versus anteromedial portal techniques for anterior cruciate ligament reconstruction, a comparative study

Side Variations of Anterior Cruciate Ligament Coronal Angles: Implications for ACL Reconstruction

Age‐related changes in ACL morphology during skeletal growth and maturation are different between females and males

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