Log in

Anatomical study of the human anterior cruciate ligament stump’s tibial insertion footprint

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

The aim of this study is to define the topographical relationship of the anatomical bundles of the human anterior cruciate ligament’s (ACL) stump over the tibial insertion site. Between January and April 2007, a total of 36 resected tibial plateaus were retrieved from patients who underwent total knee replacements. These samples had intact cruciate ligaments with no major osteophyte around the ACL tibial insertion footprint. The anatomical bundles of the ACL were identified and mapped, based on the topographical relationship over the tibial insertion footprint. Measurements of the dimensions of the ACL tibial footprint and tibial plateau were performed. The mean width and midsagittal depth of the tibia plateau was 78.7 ± 6.5 and 46.4 ± 5.0 mm, respectively. The mean width and midsagittal depth of the ACL tibial footprint was 10.3 ± 1.9 and 19.5 ± 2.6 mm, respectively. Out of the 36 freshly dissected ACL stumps, it was not possible to distinguish separate bundles in 14 (38.9%) cases. The average distance between the centers of the two bundles was 9.3 ± 1.8 mm. The mean AP alignment of the tibial footprint was 89.6° ± 26.4°, with a very wide range of 23°–158°. Of the 22 specimens with separate anatomical bundles, the alignment of the tibial footprint was AM–PL in six (27.3%), sagittal (85°–95°) in five (22.7), AL–PM in nine (40.9%), and lateral–medial (L–M) in two (9.1%) cases. This study provides new information about the topographical anatomy of the ACL tibial insertion footprint. Based on gross anatomy, separate anatomical bundles of the ACL can be distinguished in 61.1% [22] of the specimens. The topographical alignment of the separate bundles is varied on a very wide range.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (France)

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Amis AA, Dawkins GP (1991) Functional anatomy of the anterior cruciate ligament, Fibre bundle actions related to ligament replacements and injuries. J Bone Joint Surg Br 73:260–267

    PubMed  CAS  Google Scholar 

  2. Amis AA, Jakob RP (1998) Anterior cruciate ligament graft positioning, tensioning and twisting. Knee Surg Sports Traumatol Arthrosc 6(Suppl 1):S2–12

    Article  PubMed  Google Scholar 

  3. Arnoczky SP (1983) Anatomy of the anterior cruciate ligament. Clin Orthop Relat Res:19–25

    Google Scholar 

  4. Colombet P, Robinson J, Christel P, Franceschi JP, Djian P, Bellier G, Sbihi A (2006) Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy 22:984–992

    PubMed  Google Scholar 

  5. Colombet P, Robinson J, Jambou S, Allard M, Bousquet V, de Lavigne C (2006) Two-bundle, four-tunnel anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 14:629–636

    Article  PubMed  Google Scholar 

  6. Crawford C, Nyland J, Landes S, Jackson R, Chang HC, Nawab A, Caborn DN (2007) Anatomic double-bundle ACL reconstruction: a literature review. Knee Surg Sports Traumatol Arthrosc 15:946–964 discussion 945

    Article  PubMed  Google Scholar 

  7. Dienst M, Burks RT, Greis PE (2002) Anatomy and biomechanics of the anterior cruciate ligament. Orthop Clin North Am 33:605–620

    Article  PubMed  Google Scholar 

  8. Ferretti M, Levicoff EA, Macpherson TA, Moreland MS, Cohen M, Fu FH (2007) The fetal anterior cruciate ligament: an anatomic and histologic study. Arthroscopy 23:278–283

    PubMed  Google Scholar 

  9. Fuss FK (1989) Anatomy of the cruciate ligaments and their function in extension and flexion of the human knee joint. Am J Anat 184:165–176

    Article  PubMed  CAS  Google Scholar 

  10. Girgis FG, Marshall JL, Monajem A (1975) The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res:216–231

  11. Giron F, Cuomo P, Edwards A, Bull AM, Amis AA, Aglietti P (2007) Double-bundle “anatomic” anterior cruciate ligament reconstruction: a cadaveric study of tunnel positioning with a transtibial technique. Arthroscopy 23:7–13

    PubMed  Google Scholar 

  12. Harner CD, Baek GH, Vogrin TM, Carlin GJ, Kashiwaguchi S, Woo SL (1999) Quantitative analysis of human cruciate ligament insertions. Arthroscopy 15:741–749

    PubMed  CAS  Google Scholar 

  13. Morgan CD, Kalman VR, Grawl DM (1995) Definitive landmarks for reproducible tibial tunnel placement in anterior cruciate ligament reconstruction. Arthroscopy 11:275–288

    PubMed  CAS  Google Scholar 

  14. Norwood LA, Cross MJ (1979) Anterior cruciate ligament: functional anatomy of its bundles in rotatory instabilities. Am J Sports Med 7:23–26

    Article  PubMed  CAS  Google Scholar 

  15. Odensten M, Gillquist J (1985) Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg Am 67:257–262

    PubMed  CAS  Google Scholar 

  16. Petersen W, Tillmann B (2002) Anatomy and function of the anterior cruciate ligament. Orthopade 31:710–718

    Article  PubMed  CAS  Google Scholar 

  17. Petersen W, Zantop T (2007) Anatomy of the anterior cruciate ligament with regard to its two bundles. Clin Orthop Relat Res 454:35–47

    Article  PubMed  Google Scholar 

  18. Staubli HU, Rauschning W (1994) Tibial attachment area of the anterior cruciate ligament in the extended knee position, Anatomy and cryosections in vitro complemented by magnetic resonance arthrography in vivo. Knee Surg Sports Traumatol Arthrosc 2:138–146

    Article  PubMed  CAS  Google Scholar 

  19. Weber W WE (1836) Mechanik der menschlichen Gehwerkzeuge. Dieterichsche Buchhandlung Göttingen

  20. Yasuda K, Konda E, Ichiyama H, Tanabe Y, Tohyama H (2005) Surgical and biomechanical concepts of anatomic anterior cruciate ligament anterior cruciate ligament reconstruction. Oper Tech Orthop 15:96–102

    Article  Google Scholar 

  21. Yasuda K, Kondo E, Ichiyama H, Kitamura N, Tanabe Y, Tohyama H, Minami A (2004) Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy 20:1015–1025

    PubMed  Google Scholar 

  22. Zantop T, Herbort M, Raschke MJ, Fu FH, Petersen W (2007) The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation. Am J Sports Med 35:223–227

    Article  PubMed  Google Scholar 

  23. Zantop T, Petersen W, Sekiya JK, Musahl V, Fu FH (2006) Anterior cruciate ligament anatomy and function relating to anatomical reconstruction. Knee Surg Sports Traumatol Arthrosc 14:982–992

    Article  PubMed  Google Scholar 

  24. Zantop T, Petersen W, Fu F (2005) Anatomy of the anterior cruciate ligament. Oper Tech Orthop 15:20–28

    Article  Google Scholar 

  25. Zelle BA, Brucker PU, Feng MT, Fu FH (2006) Anatomical double-bundle anterior cruciate ligament reconstruction. Sports Med 36:99–108

    Article  PubMed  Google Scholar 

  26. Zhao J, He Y, Wang J (2007) Double-bundle anterior cruciate ligament reconstruction: four versus eight strands of hamstring tendon graft. Arthroscopy 23:766–770

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors report no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to András Tállay.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tállay, A., Lim, MH. & Bartlett, J. Anatomical study of the human anterior cruciate ligament stump’s tibial insertion footprint. Knee Surg Sports Traumatol Arthr 16, 741–746 (2008). https://doi.org/10.1007/s00167-008-0552-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-008-0552-8

Keywords

Navigation