The present study aimed to investigate the three-dimensional topographic anatomy of the anterior cruciate ligament (ACL) bundle attachment in both ACL-rupture and ACL-intact patients who suffered a noncontact knee injury and identify potential differences.
Magnetic resonance images of 90 ACL-rupture knees and 90 matched ACL-intact knees, who suffered a noncontact knee injury, were used to create 3D ACL insertion models.
In the ACL-rupture knees, the femoral origin of the anteromedial (AM) bundle was 24.5 ± 9.0% posterior and 45.5 ± 10.5% proximal to the flexion–extension axis (FEA), whereas the posterolateral (PL) bundle origin was 35.5 ± 12.5% posterior and 22.4 ± 10.3% distal to the FEA. In ACL-rupture knees, the tibial insertion of the AM-bundle was 34.3 ± 4.6% of the tibial plateau depth and 50.7 ± 3.5% of the tibial plateau width, whereas the PL-bundle insertion was 47.5 ± 4.1% of the tibial plateau depth and 56.9 ± 3.4% of the tibial plateau width. In ACL-intact knees, the origin of the AM-bundle was 17.5 ± 9.1% posterior (p < 0.01) and 42.3 ± 10.5% proximal (n.s.) to the FEA, whereas the PL-bundle origin was 32.1 ± 11.1% posterior (n.s.) and 16.3 ± 9.4% distal (p < 0.01) to the FEA. In ACL-intact knees, the insertion of the AM-bundle was 34.4 ± 6.6% of the tibial plateau depth (n.s.) and 48.1 ± 4.6% of the tibial plateau width (n.s.), whereas the PL-bundle insertion was 42.7 ± 5.4% of the tibial plateau depth (p < 0.01) and 57.1 ± 4.8% of the tibial plateau width (n.s.).
The current study revealed variations in the three-dimensional topographic anatomy of the native ACL between ACL-rupture and ACL-intact knees, which might help surgeons who perform anatomical double-bundle reconstruction surgery.
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This project was sponsored by the National Natural Science Foundation of China (31771017, 31972924), the Science and Technology Commission of Shanghai Municipality (16441908700), the Innovation Research Plan supported by Shanghai Municipal Education Commission (ZXWF082101), the National Key R&D Program of China (2017YFC0110700, 2018YFF0300504, and 2019YFC0120600), the Natural Science Foundation of Shanghai (18ZR1428600), and the Interdisciplinary Program of Shanghai Jiao Tong University (ZH2018QNA06, YG2017MS09).
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The authors of this manuscript have nothing to disclose that would bias our work.
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Dimitriou, D., Zou, D., Wang, Z. et al. Anterior cruciate ligament bundle insertions vary between ACL-rupture and non-injured knees. Knee Surg Sports Traumatol Arthrosc 29, 1164–1172 (2021). https://doi.org/10.1007/s00167-020-06122-1
- Anterior cruciate ligament
- Anteromedial bundle
- Posterolateral bundle
- Tibial insertion
- Double-bundle reconstruction
- Tibial footprint
- Femoral origin