Direct Anterior Cruciate Ligament Insertion to the Femur Assessed by Histology and 3-Dimensional Volume-Rendered Computed Tomography

Iwahashi, Takehiko; Shino, Konsei; Nakata, Ken; Otsubo, Hidenori; Suzuki, Toshiya; Amano, Hiroshi; Nakamura, Norimasa

doi:10.1016/j.arthro.2010.01.023

Cited by 185 publications

(162 citation statements)

References 16 publications

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“…When femoral and tibial tunnels are created within an anatomical footprint, femoral graft bending angle is mainly affected by the position of the femoral tunnel exit. Recently, the ACL anatomical footprint was intensely investigated in cadaveric studies [5,11,19]. These anatomical studies [11,24] reported that the ACL fibres inserted just posterior to the intercondylar ridge and the most posterior fibres of the femoral insertion were blending with the posterior cartilage of the lateral femoral condyle and with the periosteum of the posterior femoral shaft.…”

Section: Discussionmentioning

confidence: 99%

Relationship between femoral tunnel location and graft bending angle in outside-in and transportal technique for ACL double bundle reconstruction in 3D-CT study

Tomihara

Hashimoto

Taniuchi

et al. 2015

Arch Orthop Trauma Surg

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Section: Discussionmentioning

confidence: 99%

Relationship between femoral tunnel location and graft bending angle in outside-in and transportal technique for ACL double bundle reconstruction in 3D-CT study

Tomihara

Hashimoto

Taniuchi

et al. 2015

Arch Orthop Trauma Surg

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“…7,8,10,15,24,28,32 The femoral soft tissue attachment of the ACL is not a circle but an ellipse, as recently highlighted by Fu and Jordan,9 who noted along with others that the majority of the fibers lie posterior and proximal to the lateral intercondylar ridge. More recently, Iwahashi et al 14 demonstrated a direct and indirect insertion of the ACL on the femoral condyle, with the direct insertion of the ligament acting as ''a key link between the ligament and bone to transmit mechanical load to the joint.'' The ''ribbon'' concept of the ACL has also been described recently, 24 emphasizing the fact that not all of the fibers of the ACL are equally functional.…”

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confidence: 99%

Cortical Bony Thickening of the Lateral Intercondylar Wall: The Functional Attachment of the Anterior Cruciate Ligament

et al. 2016

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Background: The anatomy of the anterior cruciate ligament (ACL) has become the subject of much debate. There has been extensive study into attachment points of the native ligament, especially regarding the femoral attachment. Some of these studies have suggested that fibers in the ACL are of differing functional importance. Fibers with higher functional importance would be expected to exert larger mechanical stress on the bone. According to Wolff’s law, cortical thickening would be expected in these areas. Purpose: To examine cortical thickening in the region of the ACL footprint (ie, the functional footprint of the ACL). Study Design: Descriptive laboratory study. Methods: Using micro–computed tomography with resolutions ranging from 71 to 91 μm, the cortical thickness of the lateral wall of the intercondylar notch in 17 cadaveric knees was examined, along with surface topography. After image processing, the relationship between the cortical thickening and surface topology was visually compared. Results: A pattern of cortical thickening consistent with the functional footprint of the ACL was found. On average, this area was 3 times thicker than the surrounding bone and significantly thicker than the remaining lateral wall ( P < .0001). This thickening was roughly elliptical in shape (with a mean centroid at 23.5 h:31 t on a Bernard and Hertel grid) and had areas higher on the wall where greater thickness was present. The relationship to previously reported osseous landmarks was variable, although the patterns were broadly consistent with those reported in previous studies describing direct and indirect fibers of the ACL. Conclusion: The findings of this study are consistent with those of recent studies describing fibers in the ACL of differing functional importance. The area in which the thickening was found has been defined and is likely to represent the functional footprint of the ACL. Clinical Relevance: This information is of value to surgeons when determining the optimal place to position the femoral attachment site of the reconstructed ACL.

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“…Recent published studies suggest the femoral ACL attachment area is crescent-shaped with a maximum width of less than 1 cm [9,22,31]. The rectangular tunnel aperture of 5-mm width (50 mm 2 in cross-sectional area) in the RT ACLR as well as the two-tunnel technique is advantageous compared with a single round one of 10 mm (79 mm 2 in cross-sectional area) to avoid overlapping tunnels at the time of revision ACLR [43,45].…”

Section: Discussionmentioning

confidence: 98%

Surgical Technique: Revision ACL Reconstruction With a Rectangular Tunnel Technique

Shino¹,

Mae

Nakamura

2012

Clinical Orthopaedics &Amp; Related Research

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Background We developed the rectangular tunnel ACL reconstruction (RT ACLR) using a 10-mm wide bonepatellar tendon-bone (BTB) graft through rectangular tunnels with a rectangular aperture to reduce tunnel size: the cross-sectional area of the tunnels of 50 mm 2 (5 9 10 mm) in RT ACLR is less than that of 79 mm 2 in a conventional 10-mm round tunnel technique presuming the technique would be more suitable in revision ACLR with previous improperly placed tunnels.

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Direct Anterior Cruciate Ligament Insertion to the Femur Assessed by Histology and 3-Dimensional Volume-Rendered Computed Tomography

Cited by 185 publications

References 16 publications

Relationship between femoral tunnel location and graft bending angle in outside-in and transportal technique for ACL double bundle reconstruction in 3D-CT study

Relationship between femoral tunnel location and graft bending angle in outside-in and transportal technique for ACL double bundle reconstruction in 3D-CT study

Cortical Bony Thickening of the Lateral Intercondylar Wall: The Functional Attachment of the Anterior Cruciate Ligament

Surgical Technique: Revision ACL Reconstruction With a Rectangular Tunnel Technique

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