Descriptive anatomy of the anterior cruciate ligament femoral insertion

Gali, Julio Cesar; Camargo, Danilo Bordini; Oliveira, Felipe Azevedo Mendes de; Pereira, Rafael Henrique Naves; Silva, Phelipe Augusto Cintra da

doi:10.1016/j.rboe.2018.05.004

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ortopedia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Artigos Originais • Rev. bras. ortop. 53 (4) • Jul-Aug 2018 • https://doi.org/10.1016/j.rboe.2018.05.004 copy

Descriptive anatomy of the anterior cruciate ligament femoral insertion^☆ ☆ Study conducted at the Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde de Sorocaba, Departamento de Ortopedia, Sorocaba, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the morphology of the anterior cruciate ligament (ACL) femoral insertion in order to describe its anatomical features and insertion site location, with the aim of verifying if the ACL femoral insertion has individual characteristics and to provide information for appropriate femoral tunnel placement on anatomic ACL reconstruction.

Methods:

Sixteen knees obtained from amputations were studied. The ACL femoral bundles and insertion shape were observed macroscopically, and the ligaments insertion length and thickness were measured with a digital caliper. The distances between the limits of the ligament to the articular cartilage, and the measurement of the area of insertion were checked using ImageJ software.

Results:

The ACL femoral insertion site was eccentric, closer to the deep condyle cartilage. In ten knees (62.5%), the ACL femoral insertion was oval; the mean length of the insertion was 16.4 mm, varying from 11.3 to 19.3 mm, the mean thickness varied from 7.85 to 11.23 mm, and the mean area of the insertion was 99.7 mm², varying from 80.9 a 117.2 mm². The mean distances between the limits of the ligament to the superficial, deep, and inferior articular cartilage were 9.77 ± 1.21, 2.60 ± 1.20, and 1.86 ± 1.15 mm, respectively.

Conclusion:

There was a 30% to 40% difference between the minimum and maximum results of measurements of ACL femoral insertion length, thickness, and area demonstrating an important individual variation. The insertion site was eccentric, closer to the deep cartilage of the lateral femoral condyle.

Keywords:
Femur; Anterior cruciate ligament; Anatomy; Orthopedic procedures

	Age (years)	Gender	Weight (kg)	Height (m)	BMI	Femoral insertion of the ACL			Distance between ACL limit and articular cartilage			Type of insertion
						Length (mm)	Thickness (mm)	Area (mm²)	Anterior (mm)	Posterior (mm)	Distal (mm)
1	96	F	49	1.54	20.66	16.24	9.82	86.92	8.13	2.84	3.93	A
2	76	M	70	1.70	24.22	11.38	7.85	90.10	8.71	3.20	3.05	C
3	58	M	78	1.73	26.6	18.76	9.45	103.49	8.72	2.30	1.09	A
4	58	F	54	1.60	21.09	15.63	8.79	98.74	8.56	2.67	1.43	A
5	70	M	65	1.64	24.17	14.90	8.20	84.82	10.11	3.32	3.60	C
6	68	M	60	1.65	22.04	18.76	9.78	105.67	9.78	2.34	0.27	B
7	57	M	80	1.75	26.12	17.29	10.74	106.63	12.05	4.19	2.49	A
8	92	F	52	1.56	21.37	16.92	10.10	117.21	10.20	4.5	2.08	A
9	73	M	89	1.75	29.06	13.65	8.56	80.90	8.10	0.81	0.93	B
10	92	M	60	1.65	22.04	18.87	10.12	105.52	9.39	4.29	2.42	A
11	65	M	74	1.72	25.01	16.75	9.89	92.80	11.28	0.73	0.52	B
12	70	M	58	1.65	21.30	17.35	11.23	109.89	10.22	3.40	2.98	A
13	74	F	56	1.53	23.92	14.45	9.80	87.6	11.02	1.10	0.56	A
14	66	M	60	1.70	20.76	16.85	10.60	111.47	9.34	0.98	0.75	B
15	87	F	51	1.58	20.43	19.30	9.89	113.97	11.39	3.30	2.12	A
16	91	M	63	1.68	22.32	16.81	9.03	101.12	9.25	2.05	1.61	A
Mean	74.56	M	63.69	1.65	23.16	16.49	9.62	99.77	9.77	2.60	1.86
SD	13.18	11	11.55	0.07	2.47	2.12	0.93	11.33	1.21	1.20	1.15
Max.	96	F	89.00	1.75	29.06	19.30	11.23	117.21	12.05	4.29	3.93
Min	57	5	49.00	1.53	20.43	11.38	7.85	80.90	8.10	0.73	0.27

Reference	Length (mm)	Thickness (mm)	Area (mm²)
Odensten & Gillquist¹²12 Odensten M, Gillquist J. Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg Am. 1985;67(2):257-62. (1985)	18 ± 2	11 ± 2	NA
Mochizuchi et al.¹⁹19 Mochizuki T, Muneta T, Nagase T, Shirasawa S, Akita KI, Sekiya I. Cadaveric knee observation study for describing anatomic femoral tunnel placement for two-bundle anterior cruciate ligament reconstruction. Arthroscopy. 2006;22(4):356-61. (2006)	15^a a Sum of the anteromedial and posterolateral bundles.	4.7 ± 0.6	NA
Ferreti et al.¹⁵15 Ferretti M, Ekdahl M, Shen W, Fu FH. Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy. 2007;23(11):1218-25. (2007)	17.2 ± 1.2	9.9 ± 0.8	196.8 ± 23.1
Siebold et al.¹⁶16 Siebold R, Ellert T, Metz S, Metz J. Femoral insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry and arthroscopic orientation models for double-bundle bone tunnel placement-a cadaver study. Arthroscopy. 2008;24(5):585-92. (2008)	15 ± 3	8 ± 2	83 ± 19
Iwahashi et al.²⁰20 Iwahashi T, Shino K, Nakata K, Otsubo H, Suzuki T, Amano H, et al. Direct anterior cruciate ligament insertion to the femur assessed by histology and 3-dimensional volume-rendered computed tomography. Arthroscopy. 2010;26(9 Suppl):S13-20. (2010)	17.4 ± 0.9	8.0 ± 0.5	128.3 ± 10.5
Sasaki et al.¹⁰10 Sasaki N, Ishibashi Y, Tsuda E, Yamamoto Y, Maeda S, Mizukami H, et al. The femoral insertion of the anterior cruciate ligament: discrepancy between macroscopic and histological observations. Arthroscopy. 2012;28(8):1135-46. (2012)	17.7 ± 2.7	4.6 ± 0.7	NA
Smigielski et al.¹³13 Smigielski R, Zdanowicz U, Drwięga M, Ciszek B, Ciszkowska-Łysoń B, Siebold R. Ribbon like appearance of the midsubstance fibres of the anterior cruciate ligament close to its femoral insertion site: a cadaveric study including 111 knees. Knee Surg Sports Traumatol Arthrosc. 2015;23(11):3143-50. (2014)	16.0 (12.7–18.1)	3.54 (2.0–4.8)	NA
Present study	16.49 ± 2.12	9.62 ± 0.93	99.77 ± 11.33

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Conflicts of interest

The authors declare no conflicts of interest.

Brasil

Brasil

Descriptive anatomy of the anterior cruciate ligament femoral insertion☆ ☆ Study conducted at the Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde de Sorocaba, Departamento de Ortopedia, Sorocaba, SP, Brazil.

ABSTRACT

Objective:

Methods:

Results:

Conclusion:

Descriptive anatomy of the anterior cruciate ligament femoral insertion^☆ ☆ Study conducted at the Pontifícia Universidade Católica de São Paulo (PUC-SP), Faculdade de Ciências Médicas e da Saúde de Sorocaba, Departamento de Ortopedia, Sorocaba, SP, Brazil.