Descriptive anatomy of the anterior cruciate ligament femoral insertion

Abstract

ObjectiveTo evaluate the morphology of the anterior cruciate ligament (ACL) femoral insertion in order to describe its anatomical features and insertion site location, with the aim of verifying if the ACL femoral insertion has individual characteristics and to provide information for appropriate femoral tunnel placement on anatomic ACL reconstruction.MethodsSixteen knees obtained from amputations were studied. The ACL femoral bundles and insertion shape were observed macroscopically, and the ligaments insertion length and thickness were measured with a digital caliper. The distances between the limits of the ligament to the articular cartilage, and the measurement of the area of insertion were checked using ImageJ software.ResultsThe ACL femoral insertion site was eccentric, closer to the deep condyle cartilage. In ten knees (62.5%), the ACL femoral insertion was oval; the mean length of the insertion was 16.4 mm, varying from 11.3 to 19.3 mm, the mean thickness varied from 7.85 to 11.23 mm, and the mean area of the insertion was 99.7 mm2, varying from 80.9 a 117.2 mm2. The mean distances between the limits of the ligament to the superficial, deep, and inferior articular cartilage were 9.77 ± 1.21, 2.60 ± 1.20, and 1.86 ± 1.15 mm, respectively.ConclusionThere was a 30% to 40% difference between the minimum and maximum results of measurements of ACL femoral insertion length, thickness, and area demonstrating an important individual variation. The insertion site was eccentric, closer to the deep cartilage of the lateral femoral condyle.

The morphology of the femoral footprint of the anterior cruciate ligament changes with aging from a large semicircular shape to a small flat ribbon-like shape

“…The reported age ranges from 57 to 83 years of age. Araki et al reported a mean age of 62.0 years [ 1 ], Colombet et al 75 years [ 3 ], Fujimaki et al 57.5 years [ 8 ], Gali et al 74 years [ 9 ], Hart et al 82.5 years [ 13 ], Iriuchisima et al 82.5 years [ 16 ] and 83 years [ 17 ], Iwama et al 80 years [ 19 ], Mochizuki et al 61.3 years [ 25 ], Sasaki et al 69.8 years [ 34 ], Siebold et al 82 years, [ 36 ] Suruga et al 83 years, [39 years and 78.8 years [ 38 ]], Kim et al 70 years, [ 20 ] and Tampere et al 81.5 years [ 41 ]. These results are evidently lower than what we observed in patients under 50 years of age, where they presented a larger direct femoral insertion area; 114 mm 2 (SD ± 17) in females and 122 mm 2 (SD ± 20) in males.…”

Anterior cruciate ligament reconstruction, can an anatomic femoral tunnel be achieved with the trans-tibial technique? Cadaveric study

“…This is important considering the high individual variability of the ACL anatomy. In one study, the anatomical characteristics of the ACL were recorded with n = 16 (femoral insertion length, thickness and area) resulting in differences between 30% and 40% in these variables [ 2 ]. Knowledge of the anatomy of the ACL is the cornerstone of the steps in these techniques.…”

Gender Differences of the ACL Insertion Sites

“…В целом размер областей прикрепления ПКС в коленных суставах у женщин был существенно меньшим (на 36-49%), чем у мужчин. В то же время в отдельных клинических исследованиях отмечалась значительная вариабильность размеров областей прикрепления ПКС, часто не зависящая от половой принадлежности [46,47]. Так, S. Kopf с соавторами выявляли значимые, но слабые корреляции площади областей прикрепления ПКС с ростом, весом, индексом массы тела каждого пациента [48].…”