Skip to main content
SpringerLink
Log in

Blumensaat’s line is not always straight: morphological variations of the lateral wall of the femoral intercondylar notch

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

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Purpose

The purpose of this study was to evaluate the morphological variations of the lateral wall of the femoral intercondylar notch.

Methods

Fifty-two non-paired human cadaver knees were used. All soft tissues around the knee were resected except the ACL. The ACL was cut in the middle, and the femoral bone was cut at the most proximal point of the femoral notch parallel to the plane of the femoral bone shaft. The ACL was carefully dissected, and the periphery of the ACL insertion site was outlined on the femoral side. An accurate lateral view of the femoral condyle was photographed with a digital camera, and the images were downloaded to a personal computer. The morphological variations of Blumensaat’s line, the height and area of the lateral wall of the femoral intercondylar notch and the size of the femoral ACL footprints were measured with Image J software.

Results

Blumensaat’s line exhibited three types of morphological variations. A straight line was observed in 19 knees (37 %) (straight type). A protrusion spanning less than half of the line was observed at the proximal part of Blumensaat’s line in 10 knees (19 %) (small hill type). A protrusion spanning more than half of the line was observed at the proximal part of the line in 23 knees (44 %) (large hill type). In some knees with this large hill type variation, the appearance was similar to that of anterior spur. No significant differences between these three types were observed in either the height and area of the lateral wall of the femoral intercondylar notch or the area of the femoral ACL footprint.

Conclusion

In conclusion, Blumensaat’s line has three types of morphological variations (straight, small hill and large hill types). For the clinical relevance, when ACL surgery is performed in knees with small or large hill type variations, surgeons should pay close attention to femoral tunnel evaluation and placement, especially for the use of Quadrant method. The grid placement of Quadrant method would be changed in the knees of these type variations.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

ACL:

Anterior cruciate ligament

AM:

Antero-medial bundle

PL:

Postero-lateral bundle

References

  1. Bernard M, Hertel P, Hornung H, Cierpinski T (1997) Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 10:14–22

    CAS  PubMed  Google Scholar 

  2. Davis TJ, Shelbourne KD, Klootwyk TE (1999) Correlation of the intercondylar notch width of the femur to the width of the anterior and posterior cruciate ligaments. Knee Surg Sports Traumatol Arthrosc 7:209–214

    Article  CAS  PubMed  Google Scholar 

  3. Farrow LD, Chen MR, Cooperman DR, Goodfellow DB, Robbin MS (2008) Radiographic classification of the femoral intercondylar notch posterolateral rim. Arthroscopy 24:1109–1114

    Article  PubMed  Google Scholar 

  4. Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23:1218–1225

    Article  PubMed  Google Scholar 

  5. Fu FH (2011) Double-bundle ACL reconstruction. Orthopedics 34(4):281–283

    Article  PubMed  Google Scholar 

  6. Iriuchishima T, Ryu K, Yorifuji H, Aizawa S, Fu FH (2014) Commonly used ACL autograft areas do not correlate with the size of the ACL footprint or the femoral condyle. Knee Surg Sports Traumatol Arthrosc 22:1573–1579

    Article  PubMed  Google Scholar 

  7. Iriuchishima T, Tajima G, Shirakura K, Morimoto Y, Kubomura T, Horaguchi T, Fu FH (2011) In vitro and in vivo AM and PL tunnel positioning in anatomical double bundle anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg 131:1085–1090

    Article  PubMed  Google Scholar 

  8. Iriuchishima T, Ingham SJ, Tajima G, Horaguchi T, Saito A, Tokuhashi Y, Van Houten AH, Aerts MM, Fu FH (2010) Evaluation of the tunnel placement in the anatomical double-bundle ACL reconstruction: a cadaver study. Knee Surg Sports Traumatol Arthrosc 18:1226–1231

    Article  PubMed  Google Scholar 

  9. Iriuchishima T, Tajima G, Ingham SJ, Shen W, Smolinski P, Fu FH (2010) Impingement pressure in the anatomical and non anatomical anterior cruciate ligament reconstruction: a cadaver study. Am J Sports Med 38:1611–1617

    Article  PubMed  Google Scholar 

  10. Iriuchishima T, Shirakura K, Yorifuji H, Aizawa S, Murakami T, Fu FH (2013) ACL footprint size is correlated with the height and area of the lateral wall of femoral intercondylar notch. Knee Surg Sports Traumatol Arthrosc 21:789–796

    Article  PubMed  Google Scholar 

  11. Iriuchishima T, Shirakura K, Fu FH (2013) Graft impingement in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 21:664–670

    Article  PubMed  Google Scholar 

  12. Jacobsen K, Bertheussen K, Gjerloff CC (1974) Characteristics of the line of Blumensaat. An experimental analysis. Acta Orthop Scand 45:764–771

    Article  CAS  PubMed  Google Scholar 

  13. Karlsson J, Irrgang JJ, van Eck CF, Samuelsson K, Mejia HA, Fu FH (2011) Anatomic single- and double-bundle anterior cruciate ligament reconstruction. Part 2: clinical application of surgical technique. Am J Sports Med 39:2016–2026

    Article  PubMed  Google Scholar 

  14. Kondo E, Yasuda K, Azuma H, Tanabe Y, Yagi T (2008) Prospective clinical comparisons of anatomic double-bundle versus single-bundle anterior cruciate ligament reconstruction procedures in 328 consecutive patients. Am J Sports Med 36:1675–1687

    Article  PubMed  Google Scholar 

  15. Kopf S, Musahl V, Tashman S, Szczodry M, Shen W, Fu FH (2009) A systematic review of the femoral origin and tibial insertion morphology of the ACL. Knee Surg Sports Traumatol Arthrosc 17:213–219

    Article  PubMed  Google Scholar 

  16. Kopf S, Pombo MW, Szczodry M, Irrgang JJ, Fu FH (2011) Size variability of the human anterior cruciate ligament insertion sites. Am J Sports Med 39:108–1013

    Article  PubMed  Google Scholar 

  17. Luites JW, Wymenga AB, Blankevoort L et al (2007) Description of the attachment geometry of the anteromedial and posterolateral bundles of the ACL from arthroscopic perspective for anatomical tunnel placement. Knee Surg Sports Traumatol Arthrosc 15:1422–1431

    Article  PubMed  PubMed Central  Google Scholar 

  18. Maeyama A, Hoshino Y, Debandi A et al (2011) Evaluation of rotational instability in the anterior cruciate ligament deficient knee using triaxial accelerometer: a biomechanical model in porcine knees. Knee Surg Sports Traumatol Arthrosc 19:1233–1238

    Article  PubMed  Google Scholar 

  19. Muneta T, Koga H, Mochizuki T et al (2007) A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double bundle techniques. Arthroscopy 23:618–628

    Article  PubMed  Google Scholar 

  20. Muneta T, Takakuda K, Yamamoto H (1997) Intercondylar notch width and its relation to the configuration and cross-sectional area of the anterior cruciate ligament. A cadaveric knee study. Am J Sports Med 25:69–72

    Article  CAS  PubMed  Google Scholar 

  21. Okada E, Matsumoto M, Ichihara D et al (2011) Cross-sectional area of posterior extensor muscles of the cervical spine in asymptomatic subjects: a 10-year longitudinal magnetic resonance imaging study. Eur Spine J 20:1567–1573

    Article  PubMed  PubMed Central  Google Scholar 

  22. Piefer JW, Pflugner TR, Hwang MD, Lobowitz JH (2012) Anterior cruciate ligament femoral footprint anatomy: systematic review of the 21st century literature. Arthroscopy 28:872–881

    Article  PubMed  Google Scholar 

  23. Seyahi A, Atalar AC, Koyuncu LO, Cinar BM, Demirhan M (2006) Blumensaat line and patellar height. Acta Orthop Traumatol Turc 40:240–247

    PubMed  Google Scholar 

  24. Shin SH, Jeon IH, Kim HJ et al (2010) Articular surface area of the coronoid process and radial head in elbow extension: surface ration in cadavers and a computed tomography in vivo. J Hand Surg Am 35:1120–1125

    Article  PubMed  Google Scholar 

  25. Shino K, Nakata K, Nakamura N et al (2008) Rectangular tunnel double-bundle anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft to mimic natural fiber arrangement. Arthroscopy 24:1178–1183

    Article  PubMed  Google Scholar 

  26. Siebold R, Ellert T, Metz S et al (2008) 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 24:585–592

    Article  PubMed  Google Scholar 

  27. Siebold R, Ellert T, Metz S et al (2008) Tibial insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry, arthroscopic landmarks, and orientation model for bone tunnel placement. Arthroscopy 24:154–161

    Article  PubMed  Google Scholar 

  28. Steiner ME, Murray MM, Rodeo SA (2008) Strategies to improve anterior cruciate ligament healing and graft placement. Am J Sports Med 36:176–189

    Article  PubMed  Google Scholar 

  29. Stijak L, Randonjic V, Nikolic V, Blagojevic Z, Aksic M, Filipovic B (2009) Correlation between the morphometric parameters of the anterior cruciate ligament and the intercondylar width: gender and age difference. Knee Surg Sports Traumatol Arthrosc 17:812–817

    Article  PubMed  Google Scholar 

  30. Tompkins M, Ma R, Hogan MV, Miller MD (2011) What’s new in sports medicine. J Bone Joint Surg Am 93:789–797

    Article  PubMed  Google Scholar 

  31. van Eck CF, Kopf S, van Dijk CN, Fu FH, Tashman S (2011) Comparison of 3-dimensional notch volume between subjects with and subjects without anterior cruciate ligament rupture. Arthroscopy 27:1235–1241

    Article  PubMed  Google Scholar 

  32. van Eck CF, Martins CA, Vyas SM, Celentano U, van Dijk CN, Fu FH (2010) Femoral intercondylar notch shape and dimensions in ACL-injured patients. Knee Surg Sports Traumatol Arthosc 18:1257–1262

    Article  Google Scholar 

  33. Wolters F, Vrooijink SH, Van Eck CF, Fu FH (2011) Does notch size predict ACL insertion site size? Knee Surg Sports Traumatol Arthrosc 19:S17–S21

    Article  PubMed  Google Scholar 

  34. Wu E, Chen M, Cooperman D, Victoroff B, Goodfellow D, Farrow LD (2011) No correlation of height or gender with anterior cruciate ligament footprint size. J Knee Surg 24:39–43

    Article  PubMed  Google Scholar 

  35. Yasuda K, Kondo E, Ichiyama H, Tanabe Y, Tohyama H (2006) Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy 22:240–251

    Article  PubMed  Google Scholar 

  36. Yasuda K, van Eck CF, Hoshino Y, Fu FH, Tashman S (2011) Anatomic single-and double-bundle anterior cruciate ligament reconstruction. Part 1: basic science. Am J Sports Med 39:1789–1799

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kamimoku Hot Springs Hospital, Minakami, Japan

    Takanori Iriuchishima

  2. Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan

    Keinosuke Ryu

  3. Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan

    Takanori Iriuchishima & Shin Aizawa

  4. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA

    Freddie H. Fu

Authors
  1. Takanori Iriuchishima
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keinosuke Ryu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shin Aizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Freddie H. Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takanori Iriuchishima.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Iriuchishima, T., Ryu, K., Aizawa, S. et al. Blumensaat’s line is not always straight: morphological variations of the lateral wall of the femoral intercondylar notch. Knee Surg Sports Traumatol Arthrosc 24, 2752–2757 (2016). https://doi.org/10.1007/s00167-015-3579-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-015-3579-7

Keywords

Search

Navigation