Abstract
To anatomically evaluate the femoral origin and tibial insertion of the anteromedial and posterolateral bands of the anterior cruciate ligament. We studied eight cadaver knees as for the following: in the femur, distance from the center of the anteromedial band to the deep cartilage and the ceiling; also in the femur, distance from the center of the posterolateral band to the deep cartilage, to the inferior cartilage and to the superficial cartilage. In the tibia, we measured the distances between the anterior tibial bone edge to the anterior region of the anteromedial band, to the center of the anteromedial band and to the center of the posterolateral band. We also measured the distance between the center of the posterolateral band to the tibial posterolateral bone and the total length of the anteroposterior tibial insertion of the anterior cruciate ligament. In the femur, the distance from the center of the anteromedial band to the deep cartilage was 6.3 ± 1.4 mm, and 11.2 ± 2 mm to the ceiling. Also in the femur, the distance from the center of the posterolateral band to the deep cartilage was 9 ± 4 mm, to the superficial cartilage 7.6 ± 1.8 mm, and to the inferior cartilage 4.2 ± 0.9 mm. In the tibia, the distance from the anterior tibial bone edge to the anterior region of the anteromedial band was 11.9 ± 2.8 mm, to the center of the anteromedial band 18.8 ± 2.6 mm, and to the center of the posterolateral band 26.5 ± 2.3 mm. The distance from the center of the posterolateral band to the tibial posterior bone edge was 19.6 ± 4 mm and the total length of the anteroposterior tibial insertion of the anterior cruciate ligament was 19.4 ± 1.8 mm. The center of the tibial insertion of the anteromedial band is approximately 20mm distant from the anterior edge of the tibia, while the center of the posterolateral band is approximately 30 mm. The distance between the center of the origin of the anteromedial band to the deep cartilage is 6mm, and to the posterior lateral 10mm.
Highlights
The incidence of anterior cruciate ligament (ACL) reconstruction is 100,000 cases per year in the United States of America[1]
The papers describe ACL anatomy in anatomical position[16], whereas surgical position is at 90° flexion[17]
Twenty different cadaver knees were dissected in order to study the anatomy in the surgical position, according to the new nomenclature[17] (Figures 1 A and B), and measurements of anatomic structures and relationships in the ACL femoral origin and tibial insertion were performed
Summary
The incidence of anterior cruciate ligament (ACL) reconstruction is 100,000 cases per year in the United States of America[1]. The papers describe ACL anatomy in anatomical position[16] (extension), whereas surgical position is at 90° flexion[17]. In the classic study by Girgis[16] it has been shown that there is change in the anatomical relationship of the ACL with the flexion movement, but it was analyzed as a single unit, regardless of having two bands. The new nomenclature suggests that, when the knee is at 90°, the anatomic relationships should be called superficial / deep, superior / inferior[17]. This applies to the femur, as in the case of the tibia there is no change in the anatomical relationship between the two situations. The objective of this study is to assess the anatomic relationships of the two macroscopic bands of the ACL in its femoral origin in surgical position and in the tibial insertion
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