Variations in Sagittal Locations of Anterior Cruciate Ligament Tibial Footprints and Their Association with Radiographic Landmarks: a Human Cadaveric Study

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2017 Nov 16

PMID 29137625

Citations 4

Authors

Hyung Joon Cho

Tae Kyun Kim

Seung-Baik Kang

Min Uk Do

Chong Bum Chang

Affiliations

Soon will be listed here.

Abstract

Background: This cadaveric study aimed to demonstrate variation of the anterior cruciate ligament (ACL) tibial attachment in the sagittal plane, and to analyze the radiographic landmarks which predict the sagittal location of the ACL tibial attachment.

Methods: In 20 cadaveric knees, native ACLs were removed and the centers of the ACL tibial and femoral attachments were marked with metal pins. Full extension lateral radiographs were then obtained in each cadaveric knee. Using the full extension lateral radiographs, the sagittal location of the ACL tibial footprint center was estimated as a percentage in the Amis and Jakob's line. Several radiographic landmarks including the geometry of Blumensaat's line and the apex of the tibial eminence were measured. Then, the relationship between the variation of the sagittal location of the ACL tibial footprint and several radiographic landmarks were analyzed using Pearson's correlation analysis.

Results: The average sagittal position of the native ACL tibial footprint was 40.9% (range: 38.0-45.0%). The line connecting the centers of the ACL footprint was nearly parallel to Blumensaat's line, with an average angle of 1.7° (range: 0-4.1°). In addition, the distance from the point where Blumensaat's line meets the tibial articular surface to the center of the ACL tibial footprint was almost consistent, at 7.6 mm on average (range: 6.4-8.7 mm). The correlation analysis revealed that the geometry of Blumensaat's line was significantly correlated with the sagittal location of the ACL tibial footprint.

Conclusion: The radiographic landmark that showed a significant correlation with the ACL tibial footprint in the full extension lateral radiographs was Blumensaat's line.

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References

Bedi A, Maak T, Musahl V, Citak M, OLoughlin P, Choi D . Effect of tibial tunnel position on stability of the knee after anterior cruciate ligament reconstruction: is the tibial tunnel position most important?. Am J Sports Med. 2010; 39(2):366-73. DOI: 10.1177/0363546510388157. View

Howell S, Clark J . Tibial tunnel placement in anterior cruciate ligament reconstructions and graft impingement. Clin Orthop Relat Res. 1992; (283):187-95. View

M Scopp J, Jasper L, Belkoff S, Moorman 3rd C . The effect of oblique femoral tunnel placement on rotational constraint of the knee reconstructed using patellar tendon autografts. Arthroscopy. 2004; 20(3):294-9. DOI: 10.1016/j.arthro.2004.01.001. View

Iriuchishima T, Ingham S, Tajima G, Horaguchi T, Saito A, Tokuhashi Y . Evaluation of the tunnel placement in the anatomical double-bundle ACL reconstruction: a cadaver study. Knee Surg Sports Traumatol Arthrosc. 2010; 18(9):1226-31. DOI: 10.1007/s00167-010-1128-y. View

Lintner D, Dewitt S, Moseley J . Radiographic evaluation of native anterior cruciate ligament attachments and graft placement for reconstruction. A cadaveric study. Am J Sports Med. 1996; 24(1):72-8. DOI: 10.1177/036354659602400113. View

Musahl V, Burkart A, Debski R, Scyoc A, Fu F, Woo S . Anterior cruciate ligament tunnel placement: Comparison of insertion site anatomy with the guidelines of a computer-assisted surgical system. Arthroscopy. 2003; 19(2):154-60. DOI: 10.1053/jars.2003.50001. View

Shea K, Apel P, Pfeiffer R, Showalter L, Traughber P . The tibial attachment of the anterior cruciate ligament in children and adolescents: analysis of magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc. 2002; 10(2):102-8. DOI: 10.1007/s00167-001-0274-7. View

Frank R, Seroyer S, Lewis P, Bach Jr B, Verma N . MRI analysis of tibial position of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2010; 18(11):1607-11. DOI: 10.1007/s00167-010-1192-3. View

Pietrini S, Ziegler C, Anderson C, Wijdicks C, Westerhaus B, Johansen S . Radiographic landmarks for tunnel positioning in double-bundle ACL reconstructions. Knee Surg Sports Traumatol Arthrosc. 2011; 19(5):792-800. DOI: 10.1007/s00167-010-1372-1. View

10.

Loh J, Fukuda Y, Tsuda E, Steadman R, Fu F, Woo S . Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. 2002 Richard O'Connor Award paper. Arthroscopy. 2003; 19(3):297-304. DOI: 10.1053/jars.2003.50084. View

11.

Kopf S, Musahl V, Tashman S, Szczodry M, Shen W, Fu F . A systematic review of the femoral origin and tibial insertion morphology of the ACL. Knee Surg Sports Traumatol Arthrosc. 2009; 17(3):213-9. DOI: 10.1007/s00167-008-0709-5. View

12.

Amis A, Jakob R . Anterior cruciate ligament graft positioning, tensioning and twisting. Knee Surg Sports Traumatol Arthrosc. 1998; 6 Suppl 1:S2-12. DOI: 10.1007/s001670050215. View

13.

Howell S . Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 1998; 6 Suppl 1:S49-55. DOI: 10.1007/s001670050223. View

14.

Buzzi R, Zaccherotti G, Giron F, Aglietti P . The relationship between the intercondylar roof and the tibial plateau with the knee in extension: relevance for tibial tunnel placement in anterior cruciate ligament reconstruction. Arthroscopy. 1999; 15(6):625-31. DOI: 10.1053/ar.1999.v15.015062. View

15.

Klos T, Habets R, Banks A, Banks S, Devilee R, Cook F . Computer assistance in arthroscopic anterior cruciate ligament reconstruction. Clin Orthop Relat Res. 1998; (354):65-9. DOI: 10.1097/00003086-199809000-00009. View

16.

Kasten P, Szczodry M, Irrgang J, Kropf E, Costello J, Fu F . What is the role of intra-operative fluoroscopic measurements to determine tibial tunnel placement in anatomical anterior cruciate ligament reconstruction?. Knee Surg Sports Traumatol Arthrosc. 2010; 18(9):1169-75. DOI: 10.1007/s00167-010-1082-8. View

17.

Harner C, Giffin J, Dunteman R, Annunziata C, Friedman M . Evaluation and treatment of recurrent instability after anterior cruciate ligament reconstruction. Instr Course Lect. 2001; 50:463-74. View

18.

Carlisle J, Parker R, Matava M . Technical considerations in revision anterior cruciate ligament surgery. J Knee Surg. 2007; 20(4):312-22. DOI: 10.1055/s-0030-1248067. View

19.

Colombet P, Robinson J, Christel P, Franceschi J, Djian P, Bellier G . Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy. 2006; 22(9):984-92. DOI: 10.1016/j.arthro.2006.04.102. View

20.

Doi M, Takahashi M, Abe M, Suzuki D, Nagano A . Lateral radiographic study of the tibial sagital insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2008; 17(4):347-51. DOI: 10.1007/s00167-008-0668-x. View