Anterior root of lateral meniscus and medial tibial spine are reliable intraoperative landmarks for the tibial footprint of anterior cruciate ligament

Dimitriou, Dimitris; Zou, Diyang; Wang, Zhongzheng; Tsai, Tsung‐Yuan; Helmy, Naeder

doi:10.1007/s00167-020-06018-0

Cited by 3 publications

(8 citation statements)

References 39 publications

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“…The tibial spine can be regarded as a bony landmark for tibial tunnel positioning. 2 A previous study investigated the correlation between the location of the tibial spine and the ACL footprint morphology with the TSP technique, and the results indicated that the location of the tibial spine was likely to influence tibial tunnel placement. 5 Both techniques positioned the tibial tunnel medially in comparison to the anatomic site.…”

Section: Discussionmentioning

confidence: 99%

“…By comparatively analyzing the magnetic resonance imaging scans of an ACL-ruptured group and an ACL-intact group, Dimitriou et al 2 found that the medial tibial ridge and ARLM might be used as reliable landmarks for anatomic ACL reconstruction. In the present study, it was found that the location of the MLTS did not differ between the 2 groups, suggesting that the MLTS is a reliable anatomic landmark for tibial tunnel placement, with little variation between patients (Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…3,20 Anatomic ACL reconstruction requires comprehensive knowledge of the ACL attachments to allow for accurate tunnel positioning. 2 To guide surgeons during reaming of the tibial tunnel and avoid intraoperative damage to the anterior root of the lateral meniscus (ARLM), several landmarks have been used by surgeons in ACL reconstruction for anatomic tibial tunnel placement, including the ACL stump, the posterior border of the ARLM, the posterior cruciate ligament (PCL), and the medial tibial spine, which has been shown to be a valid and reliable reference. 2,22,31…”

mentioning

confidence: 99%

“…5 A previous study has shown that the location of the medial and lateral tibial spine (MLTS) can affect the judgment of surgeons in determining tibial tunnel placement when applying the transportal technique in anatomic single-bundle ACL reconstruction, which may lead to tunnel misplacement. 5 However, Dimitriou et al 2 reported that both the ARLM and medial tibial spine might be reliable landmarks for an anatomic tunnel, especially in cases of revision in which the ACL stump on the tibial side is not available. Whether the medial tibial spine can be a reliable bony landmark in ACL reconstruction is still a matter of debate.…”

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confidence: 99%

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Reliability of the Tibial Spine Versus ACL Stump in Assisting Tibial Tunnel Positioning During ACL Reconstruction: Analysis Based on 3-Dimensional Computed Tomography Modeling

Liu,

Wu,

Wang

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Several techniques have been used by surgeons for anatomic tibial tunnel placement in anterior cruciate ligament (ACL) reconstruction, including the ACL stump positioning (ASP) technique and the tibial spine positioning (TSP) technique. Purpose/Hypothesis: The purpose of this study was to evaluate whether bony landmarks (medial and lateral tibial spine [MLTS]) can be a reliable reference for improving the accuracy of tibial tunnel placement in anatomic single-bundle ACL reconstruction compared with the ACL stump. It was hypothesized that the MLTS would not be a reliable bony landmark for tibial tunnel placement. Study Design: Cohort study; Level of evidence, 3. Methods: The 3-dimensional computed tomography images of 111 patients who underwent ACL reconstruction between 2020 and 2021 were included in this study. For tibial tunnel placement, the ASP technique was used in 49 patients, and the TSP technique was used in 62 patients. The 3-dimensional computed tomography images were reconstructed to enable measurements of the locations of the MLTS and tunnel center based on a grid method. Statistical analysis was conducted to compare the MLTS location and tibial tunnel position as well as the accuracy (mean distance of each actual location from the anatomic center) and precision (standard deviation of the accuracy, indicating the reproducibility of the tunnel position) of the tunnel position between the ASP and TSP groups. Results: Significant differences were observed between the ASP and TSP groups in terms of the tibial tunnel position on the mediolateral axis (46.7% ± 2.0% vs 45.9% ± 2.2%, respectively; P = .034), while no significant differences were found in terms of the accuracy (4.1% vs 4.6%, respectively; P = .259) or precision (2.1% vs 2.1%, respectively; P = .259) of tibial tunnel positioning between the 2 groups. Conclusion: In anatomic single-bundle ACL reconstruction, the use of the MLTS for tibial tunnel placement achieved comparable accuracy and precision compared with the use of ACL remnants, supporting its role as a reliable bony landmark in tibial tunnel positioning.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Reliability of the Tibial Spine Versus ACL Stump in Assisting Tibial Tunnel Positioning During ACL Reconstruction: Analysis Based on 3-Dimensional Computed Tomography Modeling

Liu,

Wu,

Wang

et al. 2023

Orthopaedic Journal of Sports Medicine

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“…To the best of our knowledge, the structural relationship between the ACL and articular cartilage has not yet been reported. Conventionally, it was believed that the tibial side of ACL did not attach to the articular cartilage, and only its attachment to the bone surface was analyzed 7 , 10 – 14 , 16 , 20 , 22 – 41 . In contrast, several studies have reported the close relationship of the tibial side of ACL with LM, describing it as an “overlap,” “adjoin,” or “adjacent” 7 , 11 , 12 , 14 – 17 .…”

Section: Discussionmentioning

confidence: 99%

Significance of the broad non-bony attachments of the anterior cruciate ligament on the tibial side

Muro

Kim

Tsukada

et al. 2022

Sci Rep

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Knowledge of the anatomy of the anterior cruciate ligament (ACL) is important to understand the function and pathology of the knee joint. However, on the tibial side of ACL, its structural relationships with the articular cartilage and lateral meniscus remain unclear. Furthermore, conventional research methods are limited to analyzing the bone attachments. We provide a comprehensive, three-dimensional anatomical description of the tibial side of the ACL that questions the principle that “a ligament is necessarily a structure connecting a bone to another bone.” In our study, 11 knees from 6 cadavers were used for macroscopic anatomical examinations, serial-section histological analyses, and three-dimensional reconstructions. The attachments of the tibial side of ACL consisted of attachments to the bone (102.6 ± 27.5 mm2), articular cartilage (40.9 ± 13.6 mm2), and lateral meniscus (6.5 ± 4.6 mm2), suggesting that the ACL has close structural relationships with the articular cartilage and lateral meniscus. Our study demonstrates that the tibial side of the ACL is not attached to the bone surface only and provides new perspectives on ligamentous attachments. Considering its attachment to the articular cartilage would enable more accurate functional evaluations of the mechanical tensioning of the ACL.

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Significant race and gender differences in anterior cruciate ligament tibial footprint location: a 3D-based analysis

Zhang

et al. 2023

J Orthop Traumatol

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Background The aim of the present study was to identify potential race- or gender-specific differences in anterior cruciate ligament (ACL) tibial footprint location from the tibia anatomical coordinate system (tACS) origin, investigate the distances from the tibial footprint to the anterior root of the lateral meniscus (ARLM) and the medial tibial spine (MTS), determine how reliable the ARLM and MTS can be in locating the ACL tibial footprint, and assess the risk of iatrogenic ARLM injuries caused by using reamers with various diameters (7–10 mm). Patients and methods Magnetic resonance images of 91 Chinese and 91 Caucasian subjects were used for the reconstruction of three-dimensional (3D) tibial and ACL tibial footprint models. The anatomical coordinate system was applied to reflect the anatomical locations of scanned samples. Results The average anteroposterior (A/P) tibial footprint location was 17.1 ± 2.3 mm and 20.0 ± 3.4 mm in Chinese and Caucasians, respectively (P < .001). The average mediolateral (M/L) tibial footprint location was 34.2 ± 2.4 mm and 37.4 ± 3.6 mm in Chinese and Caucasians, respectively (P < .001). The average difference between men and women was 2 mm in Chinese and 3.1 mm in Caucasians. The safe zone for tibial tunnel reaming to avoid ARLM injury was 2.2 mm and 1.9 mm away from the central tibial footprint in the Chinese and Caucasians, respectively. The probability of damaging the ARLM by using reamers with various diameters ranged from 0% for Chinese males with a 7 mm reamer to 30% in Caucasian females with a 10 mm reamer. Conclusions The significant race- and gender-specific differences in the ACL tibial footprint should be taken in consideration during anatomic ACL reconstruction. The ARLM and MTS are reliable intraoperative landmarks for identifying the tibial ACL footprint. Caucasians and females might be more prone to iatrogenic ARLM injury. Level of evidence: III, cohort study. Trial registration: This study has been approved by the ethical research committee of the General Hospital of Southern Theater Command of PLA under the code: [2019] No.10.

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Anterior root of lateral meniscus and medial tibial spine are reliable intraoperative landmarks for the tibial footprint of anterior cruciate ligament

Cited by 3 publications

References 39 publications

Reliability of the Tibial Spine Versus ACL Stump in Assisting Tibial Tunnel Positioning During ACL Reconstruction: Analysis Based on 3-Dimensional Computed Tomography Modeling

Reliability of the Tibial Spine Versus ACL Stump in Assisting Tibial Tunnel Positioning During ACL Reconstruction: Analysis Based on 3-Dimensional Computed Tomography Modeling

Significance of the broad non-bony attachments of the anterior cruciate ligament on the tibial side

Significant race and gender differences in anterior cruciate ligament tibial footprint location: a 3D-based analysis

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