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Anterior cruciate ligament tibial insertion site is elliptical or triangular shaped in healthy young adults: high-resolution 3-T MRI analysis

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

Abstract

Purpose

To clarify the morphology of anterior cruciate ligament (ACL) tibial insertion site in healthy young knees using high-resolution 3-T MRI.

Methods

Subjects were 50 ACL-reconstructed patients with a mean age of 21.4 ± 6.8 years. The contralateral healthy knees were scanned using high-resolution 3-T MRI. The tibial insertion sites of the anteromedial (AM) and posterolateral (PL) bundle fibres, and the ACL attachment on the anterior horn of lateral meniscus (AHLM) were segmented from the MR images, and 3D models were reconstructed to evaluate the morphology. The shape of ACL footprint was qualitatively analysed, and the size of AM and PL attachments and AHLM overlapped area was measured digitally.

Results

Tibial AM and PL bundles were clearly identified in 42 of 50 knees (84.0%). Morphology of the whole ACL tibial insertion site was elliptical in 23 knees (54.8%) and triangular in 19 knees (45.2%), but not classified as C-shape in any knees. However, the AM bundle attachment was of C-shape in 29 knees (69.0%) and band-like in 13 knees (31.0%). Overlap of ACL on AHLM was found in 26 knees (61.9%), and the size of the overlapped area was 4.8 ± 4.7% of the whole ACL insertion site.

Conclusion

3D morphology of the intact ACL tibial insertion site analysed by high-resolution 3-T MRI was elliptical or triangular in healthy young knees. However, the AM bundle insertion site was of C-shape or band-like. A small lateral portion of the ACL was overlapped with the AHLM. As for clinical relevance, these findings should be considered in order to reproduce the native ACL insertion site sufficiently.

Level of evidence

III.

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Abbreviations

ACL:

Anterior cruciate ligament

AM:

Anteromedial

PL:

Posterolateral

MRI:

Magnetic resonance imaging

ICC:

Inter-class correlation coefficients

AHLM:

Anterior horn of lateral meniscus

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA

    Yasutaka Tashiro, Gian Andrea Lucidi, Tom Gale, Kanto Nagai, Elmar Herbst, James J. Irrgang, William Anderst & Freddie H. Fu

  2. Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Yasutaka Tashiro & Yasuharu Nakashima

Authors
  1. Yasutaka Tashiro
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  2. Gian Andrea Lucidi
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  3. Tom Gale
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  4. Kanto Nagai
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  6. James J. Irrgang
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  9. Freddie H. Fu
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Corresponding author

Correspondence to Freddie H. Fu.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

This study was supported by NIH/NIAMS Grant #R01 AR056630. Y.T. was supported by JSPS Fellowships for Research Abroad (H27-787), Grant of The Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine, 2016 and International Research Fund for Subsidy of Kyushu University School of Medicine Alumni.

Ethical approval

The institutional review board (IRB) for human subject research in University of Pittsburgh (3500 Fifth Avenue, Pittsburgh, PA 15213, USA) approved all aspects of this study (ID: PRO09020493).

Informed consent

Informed consent was obtained for all patients before enrolment.

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Tashiro, Y., Lucidi, G.A., Gale, T. et al. Anterior cruciate ligament tibial insertion site is elliptical or triangular shaped in healthy young adults: high-resolution 3-T MRI analysis. Knee Surg Sports Traumatol Arthrosc 26, 485–490 (2018). https://doi.org/10.1007/s00167-017-4607-6

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