Assessment of Anterior Cruciate Ligament Tibial Footprint Sagittal Diameter and Orientation of the Ligament in the Intercondylar Notch in Indian Population: A Magnetic Resonance Imaging (MRI) Analysis.

Balgovind S Raja,Souvik Paul,Aman Verma,Siddharth R K,Varun Garg,Watson Thomas,Sukhmin Singh

doi:10.7759/cureus.7511

Balgovind S Raja, Souvik Paul + Show 5 more

Open Access

https://doi.org/10.7759/cureus.7511

Copy DOI

Journal: Cureus	Publication Date: Apr 2, 2020
Citations: 1	License type: cc-by

Affiliation: All India Institute of Medical Sciences

Abstract

Aim: To study the relevant anatomy of anterior cruciate ligament tibial footprint and orientation of the ligament in the intercondylar roof in Indian population the using MRI.Methods: A total of 70 knee MRI with intact anterior cruciate ligament (ACL) was assessed for intercondylar roof angle, ACL inclination angle, ACL-bluemensaat angle, ACL sagittal center, and tibial insertion size.Results: The ACL tibial sagittal center was found to be at 43.5% of the anteroposterior tibial length. Tibial insertion size averaged 15.40 (±1.29) mm with no significant difference in males and females (p > 0.05). The roof angle was 36.29 (± 4.02) ˚ and the ACL inclination angle and ACL-bluemensaat angle were 51.22 (± 3.39) ˚ and 4.70 (±3.35) ˚ respectively with no significant sex difference (p > 0.05).Conclusion: The ACL tibial insertion size averaged 15.40 mm and its center was at 43.51% along the Staubli and Rauschning line. The mean roof angle was 36.29 degrees and the ACL-bluemensaat angle was 4.70 degrees. Understanding of the tibial footprint morphology and the relation of the ligament to the roof of the intercondylar notch helps in anatomical graft placement during reconstruction.

Highlights

Incidences of ligament injuries in the population are on the rise due to increased involvement in sports activities [1]
Reconstruction of Anterior cruciate ligament (ACL) owing to innovations in surgical instruments and improved surgical techniques is widely performed and understanding the anatomy of the ACL tibial footprint, the orientation of the ligament in relation to the roof of the intercondylar fossa and the tibial surface helps in precise anatomical placement of the graft in ACL reconstruction [3,4,5]
Though the anatomy of the ACL is well defined in literature, currently in the Indian scenario there appears to be little literature regarding the orientation of native ACL in the intercondylar notch and its tibial foot anatomy

Summary

Introduction

Incidences of ligament injuries in the population are on the rise due to increased involvement in sports activities [1]. Reconstruction of ACL owing to innovations in surgical instruments and improved surgical techniques is widely performed and understanding the anatomy of the ACL tibial footprint, the orientation of the ligament in relation to the roof of the intercondylar fossa and the tibial surface helps in precise anatomical placement of the graft in ACL reconstruction [3,4,5]. Vaidya et al observed the variations in dimensions of the bone geometry in the Indian scenario and Mullaji et al documented the rotational axes differences of the distal femur in relation to the Caucasian population [6,7]. A comprehensive idea regarding the tibial insertion anatomy, its variations along with relations of ACL to the intercondylar roof, and its inclination to the tibial surface will guide the surgeon to achieve an accurate and impingement-free graft placement

Objectives

Methods

Results

Discussion

Conclusion