Abstract
Purpose Recently, the configuration of the anterior cruciate ligament (ACL) from its direct femoral insertion to midsubstance was found to be flat. This might have an important impact for anatomical ACL reconstruction. The purpose of this anatomical study was to evaluate the macroscopic appearance of the ACL from femoral to midsubstance.MethodsThe ACL was dissected in 111 human fresh frozen cadaver knees from its femoral insertion to midsubstance, and the shape was described. The anatomical findings were documented on digital photographs and on video. Thirty knees were sent for computed tomography (CT), magnetic resonance imaging (MRI) and histology of the femoral ACL insertion.ResultsTwo millimetres from its direct femoral insertion, the ACL fibres formed a flat ribbon in all dissected knees without a clear separation between AM and PL bundles. The ribbon was in exact continuity of the posterior femoral cortex. The width of the ribbon was between 11.43 and 16.18 mm and the thickness of the ACL was only 2.54–3.38 mm. 3D CT, MRI and the histological examination confirmed above findings.ConclusionThis is a detailed anatomical study describing the ribbon-like structure of the ACL from its femoral insertion to midsubstance. A key point was to carefully remove the surface fibrous membrane of the ACL. A total of 2–3 mm from its bony femoral insertion, the ACL formed a flat ribbon without a clear separation between AM and PL bundles. The ribbon was in exact continuity of the posterior femoral cortex. The findings of a flat ligament may change the future approach to femoral ACL footprint and midsubstance ACL reconstruction and to graft selection.Electronic supplementary materialThe online version of this article (doi:10.1007/s00167-014-3146-7) contains supplementary material, which is available to authorized users.
Highlights
The ribbon was in exact continuity of the posterior femoral cortex
This is a detailed anatomical study describing the ribbon-like structure of the anterior cruciate ligament (ACL) from its femoral insertion to midsubstance
A total of 2–3 mm from its bony femoral insertion, the ACL formed a flat ribbon without a clear separation between AM and PL bundles
Summary
It is well known that the bony femoral ACL insertion is in the shape of a crescent, with the residents ridge (= lateral intercondylar ridge) as its straight anterior border and the posterior articular margin of the lateral femoral condyle as its convex posterior border [3, 5, 6, 9, 10, 13, 15, 19, 21, 23, 36, 39, 41, 43, 45, 52]. Most ACL fibres are aligned posterior to—and directly along the lateral intercondylar ridge. The most posterior fibres of the femoral insertion are blending with the posterior cartilage of the lateral femoral condyle and with the periosteum of the posterior femoral shaft [14, 19, 25, 42, 43, 45]. Other authors reported the diameter in the range between 7 and 13 mm and the cross-sectional area to be ‘‘irregular’’, ‘‘oval’’, ‘‘corded’’ or ‘‘bundled’’ [2, 4, 6, 13, 19, 27,28,29, 36, 38, 51]
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