Blumensaat’s line is not always straight: morphological variations of the lateral wall of the femoral intercondylar notch

Iriuchishima, Takanori; Ryu, Kyung Nam; Aizawa, Shin; Fu, Freddie H.

doi:10.1007/s00167-015-3579-7

Cited by 29 publications

(57 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…According to anatomical studies, Blumensaat's line shows variations between people and can be categorized into three types according to its morphology: "straight" (an almost straight line from front to back), "small hill" (a protrusion less than half the length of Blumensaat's line is seen behind the line), and "large hill" (a protrusion more than half the length of Blumensaat's line is seen behind the line). [34][35][36] The morphology of Blumensaat's line significantly affects the position of the femoral tunnel because the presence of a protrusion ("small hill" type) skews the baseline and leads to a more anterior and lower position of the bone tunnel (as compared with the "straight" type). However, a protrusion is difficult to observe during surgery because it is obstructed by the posterior cruciate ligament.…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of the Anterior Cruciate Ligament Using Ruler-Assisted Positioning of the Femoral Tunnel Relative to the Posterior Apex of the Deep Cartilage: A Single-Center Case Series

et al. 2021

View full text Add to dashboard Cite

The techniques available to locate the femoral tunnel during anterior cruciate ligament (ACL) reconstruction have notable limitations. To evaluate whether the femoral tunnel center could be located intraoperatively with a ruler, using the posterior apex of the deep cartilage (ADC) as a landmark. This retrospective case series included consecutive patients with ACL rupture who underwent arthroscopic single-bundle ACL reconstruction at the Department of Orthopedics, Beijing Tongren Hospital between January 2014 and May 2018. During surgery, the ADC of the femoral lateral condyle was used as a landmark to locate the femoral tunnel center with a ruler. Three-dimensional computed tomography (CT) was performed within 3 days after surgery to measure the femoral tunnel position by the quadrant method. Arthroscopy was performed 1 year after surgery to evaluate the intra-articular conditions. Lysholm and International Knee Documentation Committee (IKDC) scores were determined before and 1 year after surgery. The final analysis included 82 knees of 82 patients (age = 31.7 ± 6.1 years; 70 males). The femoral tunnel center was 26 ± 1.5% in the deep-shallow (x-axis) direction and 31 ± 3.1% in the high-low (y-axis) direction, close to the “ideal” values of 27 and 34%. Lysholm score increased significantly from 38.5 (33.5–47) before surgery to 89 (86–92) at 1 year after surgery (p < 0.001). IKDC score increased significantly from 42.5 (37–47) before surgery to 87 (83.75–90) after surgery (p < 0.001). Using the ADC as a landmark, the femoral tunnel position can be accurately selected using a ruler.

show abstract

Section: Discussionmentioning

confidence: 99%

Reconstruction of the Anterior Cruciate Ligament Using Ruler-Assisted Positioning of the Femoral Tunnel Relative to the Posterior Apex of the Deep Cartilage: A Single-Center Case Series

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Although the present study outlines the initial technique to fit a cylindrical reference in the intercondylar notch, we are aware that further refinements could take into account that the notch dimensions are often variable and that the Blumensaat line is not always straight. 16,20 To our knowledge, we are the first group to use biplanar stereoradiographic imaging to describe femoral tunnel positioning in ACLR.…”

Section: Discussionmentioning

confidence: 99%

Femoral Tunnel Placement Analysis in ACL Reconstruction Through Use of a Novel 3-Dimensional Reference With Biplanar Stereoradiographic Imaging

Montreuil

Saleh

Cresson³

et al. 2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: The femoral-sided anatomic footprint of the anterior cruciate ligament (ACL) has been widely studied during the past decades. Nonanatomic placement is an important cause of ACL reconstruction (ACLR) failure. Purpose: To describe femoral tunnel placement in ACLR through use of a comprehensive 3-dimensional (3D) cylindrical coordinate system combining both the traditional clockface technique and the quadrant method. Our objective was to validate this technique and evaluate its reproducibility. Study Design: Descriptive laboratory study. Methods: The EOS Imaging System was used to make 3D models of the knee for 37 patients who had undergone ACLR. We designed an automated cylindrical reference software program individualized to the distal femoral morphology of each patient. Cylinder parameters were collected from 2 observers’ series of 3D models. Each independent observer also manually measured the corresponding parameters using a lateral view of the 3D contours and a 2-dimensional stereoradiographic image for the corresponding patient. Results: The average cylinder produced from the first observer’s EOS 3D models had a 30.0° orientation (95% CI, 28.4°-31.5°), 40.4 mm length (95% CI, 39.3-41.4 mm), and 19.3 mm diameter (95% CI, 18.6-20.0 mm). For the second observer, these measurements were 29.7° (95% CI, 28.1°-31.3°), 40.7 mm (95% CI, 39.7-41.8 mm), and 19.7 mm (95% CI, 18.8-20.6 mm), respectively. Our method showed moderate intertest intraclass correlation among all 3 measuring techniques for both length ( r = 0.68) and diameter ( r = 0.63) but poor correlation for orientation ( r = 0.44). In terms of interobserver reproducibility of the automated EOS 3D method, similar results were obtained: moderate to excellent correlations for length ( r = 0.95; P < .001) and diameter ( r = 0.66; P < .001) but poor correlation for orientation ( r = 0.29; P < .08). With this reference system, we were able to describe the placement of each individual femoral tunnel aperture, averaging a difference of less than 10 mm from the historical anatomic description by Bernard et al. Conclusion: This novel 3D cylindrical coordinate system using biplanar, stereoradiographic, low-irradiation imaging showed a precision comparable with standard manual measurements for ACLR femoral tunnel placement. Our results also suggest that automated cylinders issued from EOS 3D models show adequate accuracy and reproducibility. Clinical Relevance: This technique will open multiple possibilities in ACLR femoral tunnel placement in terms of preoperative planning, postoperative feedback, and even intraoperative guidance with augmented reality.

show abstract

“…Prema većini autora najvažniji intraoperacijski orijentir za postavljanje femoralnog tunela je LIR 23 . Iako je položaj grebena proučavalo više studija, prema nama dostupnim podatcima postoji samo jedna studija koja je analizirala položaj grebena na RTG snimkama 24 . Farrow i sur.…”

Section: Raspravaunclassified

Rendgenološka analiza Blumensaatove linije i položaja lateralnog interkondilarnog grebena – doprinos anatomskoj rekonstrukciji prednjeg križnog ligamenta

Gulan

Balenović

Jurdana

et al. 2020

Med. Flum. (Online)

View full text Add to dashboard Cite

Cilj: Cilj rada bio je ispitati oblik Blumensaatove linije te utvrditi položaj lateralnog interkondilarnog grebena u odnosu na nju. Ispitanici i metode: U radu je korišteno 12 preparata femura sa Zavoda za anatomiju Medicinskog fakulteta u Rijeci. Na svakom preparatu tankom savitljivom žicom obilježen je lateralni interkondilarni greben. Učinjena je postranična rendgenska snimka femura uz potpuno preklapanje kondila. Na snimkama je analiziran oblik Blumensaatove linije, razlika u rendgenološkoj gustoći prikaza pojedinih dijelova te položaj lateralnog interkondilarnog grebena u odnosu na Blumensaatovu liniju. Rezultati: Na rendgenološkom prikazu Blumensaatova linija bila je ravna u 25 % preparata. U 75 % preparata stražnji dio linije bio je konveksan u smjeru prema distalno. S obzirom na radiografsku gustoću Blumensaatove linije mogla se podijeliti u tri dijela. Prednji i stražnji dio imali su gustoću intenziteta kortikalne kosti, dok je gustoća srednjeg dijela odgovarala intenzitetu spongiozne kosti. Lateralni interkondilarni greben spaja se s Blumensaatovom linijom u točki koja stražnji segment dijeli u omjeru 58 % : 42 %. Lateralni greben s Blumensaatovom linijom zatvara kut od 62.40 stupnjeva. Zaključak: Blumensaatova linija u 75 % analiziranih preparata nije ravna, već je u stražnjem dijelu zaobljena s konveksitetom usmjerenim prema distalno. Na profilnoj RTG snimci LIR koljena zatvara kut od 62.40 stupnjeva.

show abstract

Blumensaat’s line is not always straight: morphological variations of the lateral wall of the femoral intercondylar notch

Cited by 29 publications

References 35 publications

Reconstruction of the Anterior Cruciate Ligament Using Ruler-Assisted Positioning of the Femoral Tunnel Relative to the Posterior Apex of the Deep Cartilage: A Single-Center Case Series

Reconstruction of the Anterior Cruciate Ligament Using Ruler-Assisted Positioning of the Femoral Tunnel Relative to the Posterior Apex of the Deep Cartilage: A Single-Center Case Series

Femoral Tunnel Placement Analysis in ACL Reconstruction Through Use of a Novel 3-Dimensional Reference With Biplanar Stereoradiographic Imaging

Rendgenološka analiza Blumensaatove linije i položaja lateralnog interkondilarnog grebena – doprinos anatomskoj rekonstrukciji prednjeg križnog ligamenta

Contact Info

Product

Resources

About