Bony Landmarks of the Anterior Cruciate Ligament Tibial Footprint

Tensho, Keiji; Shimodaira, Hiroki; Aoki, Tetsuhiro; Narita, Nobuyo; Kato, Hiroyuki; Kakegawa, Akira; Fukushima, Nanae; Moriizumi, Tetsuji; Fujii, Masahiro; Fujinaga, Yasunari; Saito, Naoto

doi:10.1177/0363546514528789

Cited by 76 publications

(48 citation statements)

References 35 publications

(41 reference statements)

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“…The most important findings of our study were that the use of anatomical tibial bony landmarks 14 , 15) (Parsons’ knob and the medial intercondylar ridge) provided a more AM position of the AM tibial tunnel, improving anterior knee laxity. In addition, MA of the tibial stump was associated with better synovial coverage of the AM graft than WA.…”

Section: Discussionmentioning

confidence: 70%

“…Functional stability would further be enhanced after reconstruction by inducing good synovial coverage of the graft and by accurately placing aperture of the tibial tunnel within the tibial footprint of the ACL. We focused on two aspects of the reconstruction technique mainly to acquire good synovial coverage and to create a reproducible anatomical tibial tunnel: preservation of a tibial stump by the use of minimal ablation (MA) of the tibial footprint of the ACL 12) and the use of bony landmarks (Parsons’ knob 14) and the medial intercondylar ridge 15) ) on the tibia to determine the position of the tibial tunnel. Our aim was to compare the outcomes of our double-bundle ACL reconstruction, using bony anatomical landmarks on the tibia performed with MA of tibial stump, to those of double-bundle reconstruction performed with wide ablation (WA) of the tibial stump of the ACL.…”

Section: Introductionmentioning

confidence: 99%

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Minimal Ablation of the Tibial Stump Using Bony Landmarks Improved Stability and Synovial Coverage Following Double-Bundle Anterior Cruciate Ligament Reconstruction

Kodama

Furumatsu

Hino

et al. 2018

Knee Surg Relat Res

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PurposeTo evaluate the clinical effects of using anatomical bony landmarks (Parsons’ knob and the medial intercondylar ridge) and minimal ablation of the tibial footprint to improve knee anterior instability and synovial graft coverage after double-bundle anterior cruciate ligament reconstruction.Materials and MethodsWe performed a retrospective comparison of outcomes between patients who underwent reconstruction with minimal ablation of the tibial footprint, using an anatomical tibial bony landmark technique, and those who underwent reconstruction with wide ablation of the tibial footprint. Differences between the two groups were evaluated using second-look arthroscopy, radiological assessment of the tunnel position, postoperative anterior knee joint laxity, and clinical outcomes.ResultsUse of the anatomical reference and minimal ablation of the tibial footprint resulted in a more anterior positioning of the tibial tunnel, with greater synovial coverage of the graft postoperatively (p=0.01), and improved anterior stability of the knee on second-look arthroscopy. Both groups had comparable clinical outcomes.ConclusionsUse of anatomical tibial bony landmarks that resulted in a more anteromedial tibial tunnel position improved anterior knee laxity, and minimal ablation improved synovial coverage of the graft; however, it did not significantly improve subjective and functional short-term outcomes.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Minimal Ablation of the Tibial Stump Using Bony Landmarks Improved Stability and Synovial Coverage Following Double-Bundle Anterior Cruciate Ligament Reconstruction

Kodama

Furumatsu

Hino

et al. 2018

Knee Surg Relat Res

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“…explored the relationship of tibial footprint with surrounding bony landmarks and bony prominences. Findings of the study suggested that the tibial footprint was present as an oval bony prominence in 58% and triangular in 42% of the knees investigated; hence, the authors recommended that the tibial bone tunnel could be placed anteromedially within the anatomic footprint during ACLR 15. While the above studies could possibly explain the positive functional outcomes in IKDC scores with an anteriorly placed tibial tunnel in our study, our intention was to place the tibial tunnel to the center of the native ACL foot print in all the cases.…”

Section: Discussionmentioning

confidence: 99%

Functional and computed tomography correlation of femoral and tibial tunnels in single-bundle anterior cruciate ligament reconstruction

Mathai¹,

Amaravathi

Pavan

et al. 2016

IJOO

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Background:An accessory anteromedial portal (AAMP) has been shown to be effective in placing an anatomically ideal femoral tunnel. It is well known that this is due to the independent femoral drilling which is possible with the AAMP. However very little is known regarding the significance of this reconstruction technique in influencing the functional outcomes of anatomic anterior cruciate ligament reconstruction (ACLR). This study documents the influence of tibial and femoral tunnel positions on functional outcomes of anatomic ACLR using the AAMP.Materials and Methods:41 patients who underwent anatomic ACLR between 2011 and 2013 were included in this prospective cohort study. The primary outcome involved the documentation of femoral and tibial tunnel positions with volume rendering imaging using a three-dimensional computed tomography (3D-CT) done at the end of 1 year. The tunnel position evaluations from the CT images were performed by an independent observer specializing in radiodiagnosis. Functional outcome measures included preoperative and postoperative Lysholm and International Knee Documentation Committee (IKDC) scores (subjective) documented by an independent investigator who was not involved with the surgical procedure, at the end of 1 year.Results:The minimum followup was 1 year. All patients achieved good clinical and functional outcomes postoperatively with no reported complications. Tunnel position evaluations with 3D-CT revealed the average tibial tunnel distance to be 15.5 mm (standard deviation [SD] =2.52) from the anterior border of the tibial plateau and the average femoral tunnel distance to be 14.33 mm (SD = 2.6) from the inferior margin of the medial surface of lateral femoral condyle and 13.72 mm (SD = 2.8) from the posterior margin of the medial surface of lateral femoral condyle. The average tunnel diameters were found to be 7.9 mm (SD = 0.72) for the tibial tunnels and 8.6 mm (SD = 1.07) for the femoral tunnels. Statistically significant correlation between the tibial tunnel distance and the IKDC scores with anterior placement of tibial tunnel were found; however, no such statistical relationship were found between the femoral tunnel positions and the functional outcome measures.Conclusion:AAMP gives an ideal approach to drill the femoral tunnel independently. However, the influence of this tunnel placement on long term functional outcomes of ACLR needs to be assessed on larger cohort of patients.

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“…Anatomic studies have been performed to understand the location of the ACL insertion [ 1 – 4 ]. The position of the tibial insertion site is bordered by Parsons' knob, the intercondylar ridge, the anterior horn of the lateral meniscus, and the medial and lateral tubercles [ 5 ]. A recent systematic review of basic science studies suggested that the anatomic centrum of the ACL tibial footprint lies 15 mm anterior to the posterior cruciate ligament and two-fifths of the M-L width of the interspinous distance [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…A recent systematic review of basic science studies suggested that the anatomic centrum of the ACL tibial footprint lies 15 mm anterior to the posterior cruciate ligament and two-fifths of the M-L width of the interspinous distance [ 6 ]. Optimal anatomic replacement of the ACL graft is essential to improve patient clinical outcomes, and detailed knowledge of native insertions is critical [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Mediolateral Differences of Proteoglycans Distribution at the ACL Tibial Footprint: Experimental Study of 16 Cadaveric Knees

Wang

Lee

2018

BioMed Research International

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This study aimed to identify the staining pattern of ACL attachment blended with cartilage of the medial tibial plateau at the tibial insertion and histologically characterize the tibial footprint. Sixteen fresh frozen cadaveric knees (mean age: 52.0 ± 6.2 years) were used for this study. The specimens were bisected in the coronal plane, in accordance with the fiber orientation of the ACL tibial attachment. Adjacent sections were then stained with hematoxylin and eosin (H&E) to observe the morphology of the ACL insertion and with fast green and Safranin-O protocols to evaluate for collagen and proteoglycans (PG). The insertion area on the tibial footprint was divided into five zones in the medial to lateral direction, which was determined by division of the section from most prominent medial tibial spine to most lateral margin of ACL attachment. Then rectangular area with a vertical length that is twice the width of respective five zones was set. Stained areas of all images were quantified positively by using ImageJ software, and the value for staining area measured was defined in percentage by multiplying whole image area by 100. The mean proportion of Safranin-O staining is significantly greater nearer to the medial tibial spine (59% in zone 1, 32% in zone 2, 13% in zone 3, 13% in zone 4, and 4% in zone 5, P < 0.001). The medial section of the tibial insertion area grew in size and increased in PG staining with more densely organized collagen arrangement with more fibrocartilage cells. The ACL tibial insertion showed a medially eccentric staining pattern by histological evaluation of the ACL attachment to cartilage. Our histological results of the eccentric biomaterial property in the medial tibial spine of ACL insertion area can be considered in making a more functional anatomic tibial tunnel placement.

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Bony Landmarks of the Anterior Cruciate Ligament Tibial Footprint

Cited by 76 publications

References 35 publications

Minimal Ablation of the Tibial Stump Using Bony Landmarks Improved Stability and Synovial Coverage Following Double-Bundle Anterior Cruciate Ligament Reconstruction

Minimal Ablation of the Tibial Stump Using Bony Landmarks Improved Stability and Synovial Coverage Following Double-Bundle Anterior Cruciate Ligament Reconstruction

Functional and computed tomography correlation of femoral and tibial tunnels in single-bundle anterior cruciate ligament reconstruction

Mediolateral Differences of Proteoglycans Distribution at the ACL Tibial Footprint: Experimental Study of 16 Cadaveric Knees

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