The Femoral Footprint Position of the Anterior Cruciate Ligament Might Be a Predisposing Factor to a Noncontact Anterior Cruciate Ligament Rupture

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

doi:10.1177/0363546519878706

Cited by 9 publications

(5 citation statements)

References 39 publications

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“…Since several anatomical differences in the tibiofemoral joint between ACL‐ruptured and healthy knees have been reported in the literature, with the most recently demonstrated difference being the position of the femoral ACL footprint [7], it was hypothesized that the location of the tibial ACL footprint would be significantly different between ACL‐ruptured and ACL‐intact knees. Therefore, the purposes of the present study were to (1) investigate the three‐dimensional, topographic anatomy of the tibial ACL footprint in both ACL‐ruptured and ACL‐intact patients, (2) identify the relationship of the tibial footprint to the ARLM and medial tibial spine (MTS), which might facilitate tunnel placement in ACL reconstruction, especially in cases of revision where the ACL stump is not available and (3) finally evaluate the reliability of the ARLM and MTS for identifying the center of the tibial ACL footprint.…”

Section: Introductionmentioning

confidence: 99%

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

Dimitriou

Zou

Wang

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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PurposeThe aims of the present study were (1) to investigate the tibial footprint location of the anterior cruciate ligament (ACL) in both ACL‐ruptured and ACL‐intact patients, (2) to identify the relationship of the tibial footprint to the anterior root of the lateral meniscus (ARLM) and medial tibial spine (MTS), and (3) to evaluate the reliability of the ARLM and MTS for identifying the center of the tibial ACL footprint. MethodsMagnetic resonance images of 90 knees with ACL rupture and 90 matched‐controlled knees were used to create three‐dimensional models of the tibia. The tibial ACL footprint was outlined on each model, and its location was measured using an anatomical coordinate system. ResultsNo significant difference in the location of the tibial footprint was found between ACL‐ruptured and ACL‐intact knees. The tibial ACL footprint was located in very close proximity to the ARLM, especially in the M/L direction. The safe zone of tibial tunnel reaming for avoiding damage to the ARLM was 2.6 mm lateral to the center of the native tibial footprint. Both the ARLM and MTS were reliable intraoperative landmarks for identifying the tibial footprint. ConclusionsOrthopedic surgeons should be aware of the safe zone of tibial tunnel reaming for avoiding injury to the ARLM. Both the ARLM and MTS might be reliable landmarks for identifying the center of the tibial ACL footprint and may facilitate tibial tunnel placement during anatomical single‐bundle ACL reconstruction, especially in cases of revision where the tibial ACL stump is not available. Level of EvidenceLevel III.

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Section: Introductionmentioning

confidence: 99%

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

Dimitriou

Zou

Wang

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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“… 28 , 29 With the same software, the ACL footprint areas of the femur and tibia were manually depicted on MRI images (Figure 1A ). 30 , 31 The subsequent analyses of the 3D models was completed by MATLAB2014.…”

Section: Methodsmentioning

confidence: 99%

Race and Gender Differences in Anterior Cruciate Ligament Femoral Footprint Location and Orientation: A 3D‐MRI Study

Zhang,

Huang,

et al. 2023

Orthopaedic Surgery

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ObjectiveThe femoral tunnel position is crucial to anatomic single‐bundle anterior cruciate ligament (ACL) reconstruction, but the ideal femoral footprint position are mostly based on small‐sized cadaveric studies and elderly patients with a single ethnic background. This study aimed to identify potential race‐ or gender‐specific differences in the ACL femoral footprint location and ACL orientation, determine the correlation between the ACL orientation and the femoral footprint location.MethodsMagnetic resonance images (MRIs) of 90 Caucasian participants and 90 matched Chinese subjects were used for reconstruction of three‐dimensional (3D) femur and tibial models. ACL footprints were sketched by several experienced orthopedic surgeons on the MRI photographs. The anatomical coordinate system was applied to reflect the ACL footprint location and orientation of scanned samples. The femoral ACL footprint locations were represented by their distance from the origin in the anteroposterior (A/P) and distal‐proximal (D/P) directions. The orientation of the ACL was described with the sagittal, coronal and transverse deviation angles. The ACL orientation and femoral footprint position were compared by the two‐sided t‐test. Multiple regression analysis was used to study the correlation between the orientation and femoral footprint position.ResultsThe average femur footprint A/P position was −6.6 ± 1.6 mm in the Chinese group and −5.1 ± 2.3 mm in the Caucasian group, (p < 0.001). The average femur footprint D/P position was −2.8 ± 2.4 mm in Chinese and − 3.9 ± 2.0 mm in Caucasians, (p = 0.001). The Chinese group had a mean difference of a 1.5 mm (6.1%) more posterior and 1.1 mm (5.3%) more proximal in the position from the flexion‐extension axis (FEA). And the males have a sagittal plane elevation about 4–5° higher than females in both racial groups. Furthermore, for every 1% (0.40 mm) increase in A/P and D/P values, the sagittal angle decreased by about 0.12° and 0.24°, respectively; the coronal angle decreased by about 0.10° and 0.30°, respectively. For every 1% (0.40 mm) increase in D/P value, the transverse angle increased by about 0.14°.ConclusionThe significant race‐ and gender‐specific differences in the femoral footprint and orientation of the ACL should be taken in consideration during anatomic single‐bundle ACL reconstruction. Furthermore, the quantitative relationship between the ACL orientation and the footprint location might provide some reference for surgeons to develop a surgical strategy in ACL single‐bundle reconstruction and revision.

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“…Finally, the surface models were imported to a self-developed MATLAB script for subsequent analyses. The anatomic coordinate system of the distal femur was reconstructed according to a previously published method based on the cylindrical axis, 5 as several studies showed that the cylindrical axis is coincident with the flexion-extension axis of the knee. 6 , 12 The femoral ACL footprint surface area was digitized on each model, and its centroid was defined as the femoral ACL center using a previously published method.…”

Section: Methodsmentioning

confidence: 99%

Influence of the Anteromedial Portal and Transtibial Drilling Technique on Femoral Tunnel Lengths in ACL Reconstruction: Results Using an MRI-Based Model

Dimitriou

Cheng

Yang

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: In anatomic anterior cruciate ligament (ACL) reconstruction, graft placement through the anteromedial (AM) portal technique requires more horizontal drilling of the femoral tunnel as compared with the transtibial (TT) technique, which may lead to a shorter femoral tunnel and affect graft-to-bone healing. The effect of coronal and sagittal femoral tunnel obliquity angle on femoral tunnel length has not been investigated. Purpose: To compare the length of the femoral tunnels created with the TT technique versus the AM portal technique at different coronal and sagittal obliquity angles using the native femoral ACL center as the starting point of the femoral tunnel. The authors also assessed sex-based differences in tunnel lengths. Study Design: Descriptive laboratory study. Methods: Magnetic resonance imaging scans of 95 knees with an ACL rupture (55 men, 40 women; mean age, 26 years [range, 16-45 years]) were used to create 3-dimensional models of the femur. The femoral tunnel was simulated on each model using the TT and AM portal techniques; for the latter, several coronal and sagittal obliquity angles were simulated (coronal, 30°, 45°, and 60°; sagittal, 45° and 60°), representing the 10:00, 10:30, and 11:00 clockface positions for the right knee. The length of the femoral tunnel was compared between the techniques and between male and female patients. Results: The mean ± SD femoral tunnel length with the TT technique was 40.0 ± 6.8 mm. A significantly shorter tunnel was created with the AM portal technique at 30° coronal/45° sagittal (35.5 ± 3.8 mm), whereas a longer tunnel was created at 60° coronal/60° sagittal (53.3 ± 5.3 mm; P < .05 for both). The femoral tunnel created with the AM portal technique at 45° coronal/45° sagittal (40.7 ± 4.8 mm) created a similar tunnel length as the TT technique. For all techniques, the femoral tunnel was significantly shorter in female patients than male patients. Conclusion: The coronal and sagittal obliquity angles of the femoral tunnel in ACL reconstruction can significantly affect its length. The femoral tunnel created with the AM portal technique at 45° coronal/45° sagittal was similar to that created with the TT technique. Clinical Relevance: Surgeons should be aware of the femoral tunnel shortening with lower coronal obliquity angles, especially in female patients.

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The Femoral Footprint Position of the Anterior Cruciate Ligament Might Be a Predisposing Factor to a Noncontact Anterior Cruciate Ligament Rupture

Cited by 9 publications

References 39 publications

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

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

Race and Gender Differences in Anterior Cruciate Ligament Femoral Footprint Location and Orientation: A 3D‐MRI Study

Influence of the Anteromedial Portal and Transtibial Drilling Technique on Femoral Tunnel Lengths in ACL Reconstruction: Results Using an MRI-Based Model

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