Tibial Insertions of the Anteromedial and Posterolateral Bundles of the Anterior Cruciate Ligament: Morphometry, Arthroscopic Landmarks, and Orientation Model for Bone Tunnel Placement

Siebold, Rainer; Ellert, Thomas; Metz, Stefan; Metz, Juergen

doi:10.1016/j.arthro.2007.08.006

Cited by 232 publications

(214 citation statements)

References 28 publications

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“…In a published anatomical dissection of 50 knees to determine areas of positioning of the two tibial tunnels, was noted significant anatomical variation and the impossibility to locate the tunnel in the center of insertion of each band, because there was not enough space for its realization 15 mm. This technique is difficult to perform leaving its questionable reproducibility.…”

Section: Resultsmentioning

confidence: 99%

Anatomical study of the positioning of guide wires for the reconstruction of the two bands of the anterior cruciate ligament using transtibial technique

et al. 2012

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PURPOSE: To determine whether it is possible and the difficulty of anatomical placement of guide wires for reconstruction of the two bands of the anterior cruciate ligament using transtibial technique and to measure the angle and positioning of the anatomic tibial guide wires for this technique. METHODS: Ten cadaver knees were dissected and a guide wire was positioned in the center of origin and insertion of each band. Were collected measurements of the distance from: 1) the entry point of the guide wire on tibial tuberosity; 2) the medial end of the tibia; 3) the tibial articular surface. Were also measured the medial and caudal angles of the guide wires. RESULTS: For the anteromedial band the medial angle was 19±5º and the caudal was 44±4º.The distances were 20±2 mm from anterior tuberosity, 26±5 mm from the tibial plateau and 25±5 mm from the medial end of the tibia. For the posterolateral band the medial angle was 26±5º and the caudal one was 36±8°. The distances were 31±6 mm for the anterior tuberosity, 24±4 mm for the tibial plateau and 17±7 mm from the end of the tibia. CONCLUSIONS: It is possible to position the guide wires of the two bands to reconstruct the anterior cruciate ligament using transtibial technique. The parameters for the proper positioning of the guide wire from anteromedial band is caudal angle of 44º with entry point 20 mm from anterior tuberosity; for the posterolateral band the caudal angle is 36º; from the tibial tuberosity the distance is 31 mm. This technique is difficult to perform leaving its questionable reproducibility.

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Section: Resultsmentioning

confidence: 99%

Anatomical study of the positioning of guide wires for the reconstruction of the two bands of the anterior cruciate ligament using transtibial technique

et al. 2012

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“…The functional anatomy of the normal ACL fiber bundles has drawn interest (Zantop et al, 2006;Siebold et al, 2008). Detailed knowledge of the bundle anatomy of the ACL is of great clinical value, particularly in ACL reconstruction surgery.…”

Section: Introductionmentioning

confidence: 99%

“…The goal of ACL reconstruction is not only to obtain the knee stability without loss of motion, but also to restore the same kinematics as the native knee. Therefore, more anatomical reconstructions in which tendon grafts were placed at original attachment sites of each fiber bundle to mimic the native anatomy as closely as possible, were developed (Odensten and Gillquist, 1985;Muneta et al, 1999;Shino et al, 2005;Zantop et al, 2006;Otsubo et al, 2007;Siebold et al, 2008). Actually, the multiple bundle ACL reconstruction such as double bundle reconstruction has been increasingly popular in the clinical settings (Muneta et al, 1999;Otsubo et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

MRI depiction and 3D visualization of three anterior cruciate ligament bundles

et al. 2016

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The anterior cruciate ligament (ACL) is divided into three fiber bundles (AM-M: anteromedial-medial, AM-L: anteromedial-lateral, PL: posterolateral). We attempted to depict the three bundles of the human ACL on MRI images and to obtain 3-dimensional visualization of them. Twenty-four knees of healthy volunteers (14 males, 10 females) were scanned by 3T-MRI using the fat suppression 3D coherent oscillatory state acquisition for the manipulation of imaging contrast (FS 3D-COSMIC). The scanned images were reconstructed after the isotropic voxel data, which allows the images to be reconstructed in any plane, was acquired. We conducted statistical examination on the identification rate of the three ACL bundles by 2D planes. Segmentation and 3D visualization of the fiber bundles using volume rendering were performed. The triple-bundle ACL was best depicted in the oblique axial plane. While the AM-M and AM-L bundles were clearly depicted in all cases, the PL bundle was not clearly visualized in two knees (8%). Therefore, the three ACL bundles were depicted in 22 knees (92%). The results of 3D visualization of the fiber arrangement agreed well with macroscopic findings of previous anatomical studies. 3T-MRI and the isotropic voxel data from FS 3D-COSMIC made it possible to demonstrate the identifiable depiction of three ACL bundles in nearly all cases. 3D visualization of the bundles could be a useful tool to understand the ACL fiber arrangement. Clin.

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“…The AM bundle has a larger area (67 mm 2 ) than the PL bundle (52 mm 2 ). The centres of the bundle insertions are 5 mm apart [27,28]. Ziegler found the ACL attachment centre was 7.5 mm medial to the anterior horn of the lateral meniscus and 13 mm anterior to the retroeminence ridge [29•].…”

Section: Anatomymentioning

confidence: 99%