Size and Shape of the Human Anterior Cruciate Ligament and the Impact of Sex and Skeletal Growth

Abstract

Background: High rates of anterior cruciate ligament (ACL) injury and surgical reconstruction in both skeletally immature and mature populations have led to many studies investigating the size and shape of the healthy ligament. The purposes of the present study were to compile existing quantitative measurements of the geometry of the ACL, its bundles, and its insertion sites and to describe effects of common covariates such as sex and age.Methods: A search of the Web of Science was conducted for studies published from January 1, 1900, to April 11, 2018, describing length, crosssectional area, volume, orientation, and insertion sites of the ACL. Two reviewers independently screened and reviewed the articles to collect quantitative data for each parameter.Results: Quantitative data were collected from 92 articles in this systematic review. In studies of adults, reports of average ACL length, cross-sectional area, and volume ranged from 26 to 38 mm, 30 to 53 mm 2 , and 854 to 1,858 mm 3 , respectively. Reported values were commonly found to vary according to sex and skeletal maturity as well as measurement technique.Conclusions: Although the geometry of the ACL has been described widely in the literature, quantitative measurements can depend on sex, age, and measurement modality, contributing to variability between studies. As such, care must be taken to account for these factors. The present study condenses measurements describing the geometry of the ACL, its individual bundles, and its insertion sites, accounting for common covariates when possible, to provide a resource to the clinical and scientific communities.Clinical Relevance: Quantitative measures of ACL geometry are informative for developing clinical treatments such as ACL reconstruction. Age and sex can impact these parameters.

Six Percent Incidence of Graft-Tunnel Mismatch in Anatomic Anterior Cruciate Ligament Reconstruction Using Bone-Patella Tendon-Bone Autograft and Anteromedial Portal Drilling

“…31 In our study, the mean IAD at 30° was 23.4 mm (range: 18-31 mm), which is likely affected by differing femoral tunnel positions when using anteromedial portal drilling in comparison to transtibial. 11 It is also important to note that the IAD is significantly shorter than the native ACL ligament (range: 27-38 mm), but it was consistent with the described length of the posterolateral bundle (22-30 mm), 34 which is typically reconstructed when performing ACLR using anteromedial portal drilling. We also found that the IAD (and the total tunnel distance) varied with knee position, becoming longer as the knee extends, which is likely because of graft anisometry encountered in anatomic ACLR.…”

Age‐related changes in ACL morphology during skeletal growth and maturation are different between females and males

“…This has motivated numerous investigations to study the age-related [21][22][23] or sex-dependent 24,25 differences in ACL morphology. A recent comprehensive review by Cone et al, 26 has provided summaries of the existing reports on a range of morphological features of the ACL. However, as noted by Cone et al, the heterogeneity in the study populations (ie, age and sex distribution) and measurement techniques (eg, imaging modality) limits the utility of those findings.…”

Is Lever Test Superior to Lachman, Pivot Shift, Drawer Tests in Diagnosing Anterior Cruciate Ligament Injuries?

“…The anterior cruciate ligament (ACL) is one of the primary ligaments of the tibio-femoral joint and has an important role in the motion and stabilization of the knee [1][2][3][4][5][6][7][8]. ACL injuries are one of the important health problems affecting the quality of life of individuals, and many reasons can lie in the etiology from injuries to wrong movements in sports activities.…”