Abstract
The fanlike extension fibers of the anterior cruciate ligament (ACL) adhere to the bone surface; regardless of the knee flexion angle, the fiber location and orientation do not change, in relation to the femoral surface. However, the ACL midsubstance fiber orientation related to the femur does change during knee motion.
The ACL femoral attachment was divided into a central area of dense fibers, with direct insertion into the femur, and anterior and posterior fanlike extension areas. The central area resisted 82–90 % of the anterior drawer force with the anterior and posterior fanlike areas at 2–3 % and 11–15 %, respectively. Among the 4 central areas, most load was carried close to the roof of the intercondylar notch.
An anatomic variation of the lateral intercondylar ridge (LIR) was identified in 94.0 % of 318 femora and the distal half of LIR was not visible in 18.4 % of these femora. The LIR was situated in the anteriormost part of the lateral condyle surface in 8.8 % and in the posteriormost part in 8.5 %. The ACL attachment anterior margin was typically located anterior to the middle and distal part of LIR.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Girgis FG, Marshall JL, Monajem A (1975) The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop Relat Res 106:216–231
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(10):1015–1025. doi:10.1016/j.arthro.2004.08.010
Takahashi M, Doi M, Abe M, Suzuki D, Nagano A (2006) Anatomical study of the femoral and tibial insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament. Am J Sports Med 34(5):787–792
Edwards A, Bull AMJ, Amis AA (2008) The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 16(1):29–36
Odensten M, Gillquist J (1985) Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg Am 67(2):257–262
Harner CD, Baek GH, Vogrin TM, Carlin GJ, Kashiwaguchi S, Woo SLY (1999) Quantitative analysis of human cruciate ligament insertions. Arthroscopy 15(7):741–749
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(11):1218–1225
Zantop T, Wellmann M, Fu FH, Petersen W (2008) Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction. Am J Sports Med 36(1):65–72
Otsubo H, Shino K, Suzuki D, Kamiya T, Suzuki T, Watanabe K, Fujimiya M, Iwahashi T, Yamashita T (2012) The arrangement and the attachment areas of three ACL bundles. Knee Surg Sports Traumatol Arthrosc 20(1):127–134. doi:10.1007/s00167-011-1576-z
Mochizuki T, Muneta T, Nagase T, Shirasawa S, Akita K, Sekiya I (2006) Cadaveric knee observation study for describing anatomic femoral tunnel placement for two-bundle anterior cruciate ligament reconstruction. Arthroscopy 22(4):356–361
Hara K, Mochizuki T, Sekiya I, Yamaguchi K, Akita K, Muneta T (2009) Anatomy of normal human anterior cruciate ligament attachments evaluated by divided small bundles. Am J Sports Med 37(12):2386–2391
Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL (2002) Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30(5):660–666
Shino K, Nakata K, Nakamura N, Toritsuka Y, Horibe S, Nakagawa S, Suzuki T (2008) Rectangular tunnel double-bundle anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft to mimic natural fiber arrangement. Arthroscopy 24(10):1178–1183. doi:10.1016/j.arthro.2008.06.010
Forsythe B, Kopf S, Wong AK, Martins CA, Anderst W, Tashman S, Fu FH (2010) The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models. J Bone Joint Surg Am 92(6):1418–1426. doi:10.2106/JBJS.I.00654
Sakane M, Fox RJ, Woo SL, Livesay GA, Li G, Fu FH (1997) In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res 15(2):285–293. doi:10.1002/jor.1100150219
Amis A, Dawkins G (1991) Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. J Bone Joint Surg Br 73(2):260–267
Hutchinson MR, Ash SA (2003) Resident’s ridge: assessing the cortical thickness of the lateral wall and roof of the intercondylar notch. Arthroscopy 19(9):931–935
Farrow LD, Gillespie RJ, Victoroff BN, Cooperman DR (2008) Radiographic location of the lateral intercondylar ridge: its relationship to Blumensaat’s line. Am J Sports Med 36(10):2002–2006. doi:10.1177/0363546508317413
Purnell ML, Larson AI, Clancy W (2008) Anterior cruciate ligament insertions on the tibia and femur and their relationships to critical bony landmarks using high-resolution volume-rendering computed tomography. Am J Sports Med 36(11):2083–2090
Mochizuki T, Fujishiro H, Nimura A, Mahakkanukrauh P, Yasuda K, Muneta T, Akita K (2014) Anatomic and histologic analysis of the mid-substance and fan-like extension fibers of the anterior cruciate ligament during knee motion, with special reference to the femoral attachment. Knee Surg Sports Traumatol Arthrosc 22(2):336–344
Iwahashi T, Shino K, Nakata K, Otsubo H, Suzuki T, Amano H, Nakamura N (2010) Direct anterior cruciate ligament insertion to the femur assessed by histology and 3-dimensional volume-rendered computed tomography. Arthroscopy 26(9):S13–S20
Sasaki N, Ishibashi Y, Tsuda E, Yamamoto Y, Maeda S, Mizukami H, Toh S, Yagihashi S, Tonosaki Y (2012) The femoral insertion of the anterior cruciate ligament: discrepancy between macroscopic and histological observations. Arthroscopy 28(8):1135–1146. doi:10.1016/j.arthro.2011.12.021
Schneider H (1956) Structure of tendon attachments. Z Anat Entwicklungsgesch 119:431–456 (in German)
Benjamin M, Evans EJ, Copp L (1986) The histology of tendon attachments to bone in man. J Anat 149:89–100
Ziegler CG, Pietrini SD, Westerhaus BD, Anderson CJ, Wijdicks CA, Johansen S, Engebretsen L, LaPrade RF (2011) Arthroscopically pertinent landmarks for tunnel positioning in single-bundle and double-bundle anterior cruciate ligament reconstructions. Am J Sports Med 39(4):743–752
Kawaguchi Y, Kondo E, Takeda R, Akita K, Yasuda K, Amis AA (2015) The role of fibers in the femoral attachment of the anterior cruciate ligament in resisting tibial displacement. Arthroscopy 31(3):435–444. doi:10.1016/j.arthro.2014.08.033
Hefzy MS, Grood ES, Noyes FR (1989) Factors affecting the region of most isometric femoral attachments. Part II: the anterior cruciate ligament. Am J Sports Med 17(2):208–216
Sidles JA, Larson RV, Garbini JL, Downey DJ, Matsen FA 3rd (1988) Ligament length relationships in the moving knee. J Orthop Res 6(4):593–610. doi:10.1002/jor.1100060418
Mommersteeg TJ, Blankevoort L, Kooloos JG, Hendriks JC, Kauer JM, Huiskes R (1994) Nonuniform distribution of collagen density in human knee ligaments. J Orthop Res 12(2):238–245. doi:10.1002/jor.1100120213
Petersen W, Tillmann B (1999) Structure and vascularization of the cruciate ligaments of the human knee joint. Anat Embryol (Berl) 200(3):325–334
Butler DL, Guan Y, Kay MD, Cummings JF, Feder SM, Levy MS (1992) Location-dependent variations in the material properties of the anterior cruciate ligament. J Biomech 25(5):511–518
Tsukada S, Fujishiro H, Watanabe K, Nimura A, Mochizuki T, Mahakkanukrauh P, Yasuda K, Akita K (2014) Anatomic variations of the lateral intercondylar ridge: relationship to the anterior margin of the anterior cruciate ligament. Am J Sports Med 42(5):1110–1117. doi:10.1177/0363546514524527
Farrow LD, Chen MR, Cooperman DR, Victoroff BN, Goodfellow DB (2007) Morphology of the femoral intercondylar notch. J Bone Joint Surg Am 89(10):2150
van Eck CF, Lesniak BP, Schreiber VM, Fu FH (2010) Anatomic single- and double-bundle anterior cruciate ligament reconstruction flowchart. Arthroscopy 26(2):258–268. doi:10.1016/j.arthro.2009.07.027
Vaiyapuri S, Vaiyapuri R, Ashokan R, Ramasamy K, Nattamaisundar K, Jeyaraj A, Chandran V, Gajjeraman P, Baksh MF, Gibbins JM, Hutchinson EG (2013) Snakebite and its socio-economic impact on the rural population of Tamil Nadu, India. PLoS ONE 8(11), e80090. doi:10.1371/journal.pone.0080090
Kondo E, Merican AM, Yasuda K, Amis AA (2011) Biomechanical comparison of anatomic double-bundle, anatomic single-bundle, and nonanatomic single-bundle anterior cruciate ligament reconstructions. Am J Sports Med 39(2):279–288. doi:10.1177/0363546510392350
Suzuki T, Shino K, Nakagawa S, Nakata K, Iwahashi T, Kinugasa K, Otsubo H, Yamashita T (2011) Early integration of a bone plug in the femoral tunnel in rectangular tunnel ACL reconstruction with a bone-patellar tendon-bone graft: a prospective computed tomography analysis. Knee Surg Sports Traumatol Arthrosc 19:S29–S35. doi:10.1007/s00167-011-1481-5
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer Japan
About this chapter
Cite this chapter
Mochizuki, T., Akita, K. (2016). Functional Anatomy of the ACL Fibers on the Femoral Attachment. In: Ochi, M., Shino, K., Yasuda, K., Kurosaka, M. (eds) ACL Injury and Its Treatment. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55858-3_1
Download citation
DOI: https://doi.org/10.1007/978-4-431-55858-3_1
Published:
Publisher Name: Springer, Tokyo
Print ISBN: 978-4-431-55856-9
Online ISBN: 978-4-431-55858-3
eBook Packages: MedicineMedicine (R0)