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Morphological size evaluation of the mid-substance insertion areas and the fan-like extension fibers in the femoral ACL footprint

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to evaluate the detailed anatomy of the femoral anterior cruciate ligament (ACL) insertion site, with special attention given to the morphology of the mid-substance insertion areas and the fan-like extension fibers.

Methods

Twenty-three non-paired human cadaver knees were used (7 Males, 16 Females, median age 83, range 69–96). All soft tissues around the knee were resected except the ligaments. The ACL was divided into antero-medial (AM) and postero-lateral (PL) bundles according to the difference in macroscopic tension patterns. The ACL was carefully dissected and two outlines were made of the periphery of each bundle insertion site: those which included and those which excluded the fan-like extension fibers. An accurate lateral view of the femoral condyle was photographed with a digital camera, and the images were downloaded to a personal computer. The area of each bundle, including and excluding the fan-like extension fibers, was measured with Image J software (National Institution of Health). The width and length of the mid-substance insertion sites were also evaluated using same image.

Results

The femoral ACL footprint was divided into four regions (mid-substance insertion sites of the AM and PL bundles, and fan-like extensions of the AM and PL bundles). The measured areas of the mid-substance insertion sites of the AM and PL bundles were 35.5 ± 12.5, and 32.4 ± 13.8 mm2, respectively. Whole width and length of the mid-substance insertion sites were 5.3 ± 1.4, and 15.5 ± 2.9 mm, respectively. The measured areas of the fan-like extensions of the AM and PL bundles were 27 ± 11.5, and 29.5 ± 12.4 mm2, respectively.

Conclusion

The femoral ACL footprint was divided into quarters of approximately equal size (mid-substance insertion sites of the AM and PL bundles, and fan-like extensions of the AM and PL bundles). For clinical relevance, to perform highly reproducible anatomical ACL reconstruction, the presence of the fan-like extension fibers should be taken into consideration.

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Abbreviations

ACL:

Anterior cruciate ligament

AM:

Antero-medial bundle

PL:

Postero-lateral bundle

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Nihon University Hospital, Tokyo, Japan

    Makoto Suruga, Takashi Horaguchi, Yoshiyuki Yahagi & Genki Iwama

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

    Takanori Iriuchishima & Shin Aizawa

  3. Department of Orthopedic Surgery, Kamimoku Hot Springs Hospital, Minakami, Japan

    Takanori Iriuchishima

  4. Department of Orthopedic Surgery, Nihon University School of Medicine, Tokyo, Japan

    Yasuaki Tokuhashi

Authors
  1. Makoto Suruga
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  2. Takashi Horaguchi
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  3. Takanori Iriuchishima
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  4. Yoshiyuki Yahagi
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  5. Genki Iwama
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  6. Yasuaki Tokuhashi
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Corresponding author

Correspondence to Takanori Iriuchishima.

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Conflict of interest

The authors declare that they have no conflict of interest on this study.

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There is no funding source.

Ethical approval

This study has been approved by the ethics committee. The no.: 20-14.

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Suruga, M., Horaguchi, T., Iriuchishima, T. et al. Morphological size evaluation of the mid-substance insertion areas and the fan-like extension fibers in the femoral ACL footprint. Arch Orthop Trauma Surg 137, 1107–1113 (2017). https://doi.org/10.1007/s00402-017-2726-7

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  • DOI: https://doi.org/10.1007/s00402-017-2726-7

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