Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 15, Issue 12, pp 1414–1421 | Cite as

The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament

Part 1: Tibial attachment
  • Andrew Edwards
  • Anthony M. J. Bull
  • Andrew A. AmisEmail author


The tibial attachments of the individual anteromedial (AM) and posterolateral (PL) fibre bundles and the entire attachment of the anterior cruciate ligament are described, relating them to consistent bony landmarks; 55 fresh-frozen specimens were measured. The fibre bundles were separated and excised at their attachments and their peripheries marked with a pen. High-resolution scaled digital photographs were taken of each dissected specimen and transferred onto a computer for analysis. A wide variation was found when using the posterior tibial axis, the anterior tibial surface and the medial tibial spine as reference points. The most consistent measurements used the tibial interspinous “over-the-back” ridge as a datum. The attachments of the PL and AM bundles were centred 10 ± 1 mm (mean ± SD) and 17 ± 2 mm anterior to the over-the-back ridge. They were 4 ± 1 and 5 ± 1 mm, respectively, lateral to the medial tibial spine border. The positions of 6 mm circles in the posterior-medial limits of the fibre bundles (representing tunnels in a double-tunnel reconstruction) were measured. The overall dimensions of the tibial plateaux correlated significantly with many measurements. The results from this study could be used to guide ACL reconstruction techniques.


Knee Fibre bundles ACL Attachments 



This research was kindly funded by the London Department of Postgraduate Medical and Dental Education. We acknowledge Ealing Hospital NHS trust for the knee specimens. Dr. Bull was supported by the Arthritis Research Campaign, a charity based in Chesterfield, UK. The authors are not aware of any potential conflict of interest relating to this article.


  1. 1.
    Amis AA, Beynnon B, Blankevoort L, Chambat P, Christel P, Durselen L, Friederich N, Grood E, Hertel P, Jakob R (1994) Proceedings of the ESSKA scientific workshop on reconstruction of the anterior and posterior cruciate ligaments. Knee Surg Sports Traumatol Arthrosc 2:124–132PubMedCrossRefGoogle Scholar
  2. 2.
    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 73:260–267PubMedGoogle Scholar
  3. 3.
    Amis AA, Jakob RP (1998) Anterior cruciate ligament graft positioning, tensioning and twisting. Knee Surg Sports Traumatol Arthrosc 6(Suppl 1):S2–S12PubMedCrossRefGoogle Scholar
  4. 4.
    Berg EE (1993) Parsons’ knob (tuberculum intercondylare tertium). A guide to tibial anterior cruciate ligament insertion. Clin Orthop Relat Res 292: 229–231PubMedGoogle Scholar
  5. 5.
    Chhabra A, Starman JS, Ferretti M, Vidal AF, Zantop T, Fu FH (2006) Anatomic, radiographic, biomechanical, and kinematic evaluation of the anterior cruciate ligament and its two functional bundles. J Bone Joint Surg Am 88(Suppl 4):2–10PubMedCrossRefGoogle Scholar
  6. 6.
    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 22:984–992PubMedCrossRefGoogle Scholar
  7. 7.
    Ferretti M, Levicoff EA, Macpherson TA, Moreland MS, Cohen M, Fu FH (2007) The fetal anterior cruciate ligament: an anatomic and histologic study. Arthroscopy 23:278–283PubMedCrossRefGoogle Scholar
  8. 8.
    Friederich NF, O’Brien WR (1992) Functional anatomy of the cruciate ligaments. In: Jakob RP, Staubli HU (eds) The knee and the cruciate ligaments. Springer, BerlinGoogle Scholar
  9. 9.
    Harner CD, Baek GH, Vogrin TM, Carlin GJ, Kashiwaguchi S, Woo SL (1999) Quantitative analysis of human cruciate ligament insertions. Arthroscopy 15:741–749PubMedCrossRefGoogle Scholar
  10. 10.
    Howell SM (1998) Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 6:S49–S55PubMedCrossRefGoogle Scholar
  11. 11.
    Hutchinson MR, Bae TS (2001) Reproducibility of anatomic tibial landmarks for anterior cruciate ligament reconstructions. Am J Sports Med 29:777–780PubMedGoogle Scholar
  12. 12.
    Ikeda H, Muneta T, Niga S, Hoshino A, Asahina S, Yamamoto H (1999) The long-term effects of tibial drill hole position on the outcome of anterior cruciate ligament reconstruction. Arthroscopy 15:287–291PubMedCrossRefGoogle Scholar
  13. 13.
    Jackson DW, Schaefer RK (1990) Cyclops syndrome: loss of extension following intra-articular anterior cruciate ligament reconstruction. Arthroscopy 6:171–178PubMedCrossRefGoogle Scholar
  14. 14.
    Kurosawa H, Walker PS, Abe S, Garg A, Hunter T (1985) Geometry and motion of the knee for implant and orthotic design. J Biomech 18:487–499PubMedCrossRefGoogle Scholar
  15. 15.
    Morgan CD, Kalman VR, Grawl DM (1997) The anatomic origin of the posterior cruciate ligament: where is it? Reference landmarks for PCL reconstruction. Arthroscopy 13:325–331PubMedCrossRefGoogle Scholar
  16. 16.
    Muneta T, Yamamoto H, Sakai H, Ishibashi T, Furuya K (1993) Relationship between changes in length and force in in vitro reconstructed anterior cruciate ligament. Am J Sports Med 21:299–304PubMedCrossRefGoogle Scholar
  17. 17.
    Odensten M, Gillquist J (1985) Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg Am 67:257–262PubMedGoogle Scholar
  18. 18.
    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 15:285–293PubMedCrossRefGoogle Scholar
  19. 19.
    Sapega AA, Moyer RA, Schneck C, Komalahiranya N (1990) Testing for isometry during reconstruction of the anterior cruciate ligament. Anatomical and biomechanical considerations. J Bone Joint Surg Am 72:259–267PubMedGoogle Scholar
  20. 20.
    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 2:138–146PubMedCrossRefGoogle Scholar
  21. 21.
    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 34:787–792PubMedCrossRefGoogle Scholar
  22. 22.
    Takeuchi R, Saito T, Mituhashi S, Suzuki E, Yamada I, Koshino T (2002) Double-bundle anatomic anterior cruciate ligament reconstruction using bone-hamstring-bone composite graft. Arthroscopy 18:550–555PubMedCrossRefGoogle Scholar
  23. 23.
    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 30:660–666PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Andrew Edwards
    • 1
  • Anthony M. J. Bull
    • 2
  • Andrew A. Amis
    • 3
    Email author
  1. 1.Department of Mechanical EngineeringImperial College LondonLondonUK
  2. 2.Bioengineering DepartmentImperial College LondonLondonUK
  3. 3.Departments of Mechanical Engineering and Musculoskeletal SurgeryImperial College LondonLondonUK

Personalised recommendations