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Restoration of the tibial ACL footprint area and geometry using the Modified Insertion Site Table

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

Abstract

Purpose

This article is based on the concept of complete footprint restoration. It introduces a “Modified Insertion Site Table” for individual size-matched single- (SB) and double-bundle (DB) ACL reconstruction, which gives surgical guidelines for graft diameters and drill angles according to the restored tibial insertion site area and geometry.

Methods

Potential graft diameters and drill angles were matched for all individual tibial insertion site lengths between 8 and 21 mm. A “Modified Insertion Site Table” was calculated to achieve a maximum of area restoration of the tibial ACL footprint for each of these insertion site lengths. The geometry of the restored footprint was considered.

Results

A wide ACL footprint up to a 16-mm-long insertion site might be best restored with a SB-, a narrow one with a DB-ACL reconstruction. In a 17-mm-long insertion site, SB- and DB-ACL reconstructions restore a similar amount of footprint area, so geometry considerations of the footprint may decide which surgical technique may be favourized. SB can restore a maximum length of 13.1 mm and DB up to 21 mm. The width of the restored area depends on the drill bit diameter(s) and is larger for SB in most cases. In larger footprints, DB can replicate up to 63% more area and 37% more length than SB-ACL reconstruction.

Conclusions

Anatomical footprint restoration requires assessment of the length, width, and the orientation of the tibial ACL insertion site. Both SB- and DB-ACL reconstruction may achieve a wide range of area and geometric restoration of the individual ACL footprint. While SB-ACL reconstruction may be best used for wide insertion sites with up to 16 mm in length, DB-ACL reconstruction has the potential to restore narrow and larger footprints up to 21 mm in length. The “Modified Insertion Site Table” resumes the concept for orientation during surgery.

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References

  1. Arnoczky SP (1983) Anatomy of the anterior cruciate ligament. Clin Orthop Relat Res 172:19–25

    PubMed  Google Scholar 

  2. Colombet P, Robinson J, Christel P, Franceschi JP, Djian P, Bellier G, Sbihi A (2006) Morphology of anterior cruciate ligament attachment for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy 22:984–992

    Article  PubMed  Google Scholar 

  3. Dodds JA, Arnoczky SP (1994) Anatomy of the anterior cruciate ligament: a blueprint for repair and reconstruction. Arthroscopy 10:132–139

    Article  PubMed  CAS  Google Scholar 

  4. Duthon VB, Barea C, Abrassart S, Fasel JH, Fritschy D, Ménétrey J (2006) Anatomy of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 14:204–213

    Article  PubMed  CAS  Google Scholar 

  5. Edwards A, Bull AM, Amis AA (2007) The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament: part 1: tibial attachment. Knee Surg Sports Traumatol Arthrosc 15:1414–1421

    Article  PubMed  Google Scholar 

  6. Ferretti M, Levicoff EA, Macpherson TA, Moreland MS, Cohen M, Fu FH (2007) The fetal anterior cruciate ligament: an anatomic and histologic study. Arthroscopy 23:278–282

    Article  PubMed  Google Scholar 

  7. Fu FH, Cohen SB (2008) Current concepts in ACL reconstruction. SLACK Incorporated 21–32:301–308

    Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. Hamner DL, Brown CH Jr, Steiner ME, Hecker AT, Hayes WC (1999) Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. J Bone Joint Surg Am 81:549–557

    PubMed  CAS  Google Scholar 

  10. 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 37:2386–2391

    Article  PubMed  Google Scholar 

  11. Harner CD, Baek GH, Vogrin TM, Carlin GJ, Kashiwaguchi S, Woo SL (1999) Quantitative analysis of human cruciate ligament insertions. Arthroscopy 15:741–749

    Article  PubMed  CAS  Google Scholar 

  12. Kopf S, Martin DE, Tashman S, Fu FH (2010) Effect of tibial drill angles on bone tunnel aperture during anterior cruciate ligament reconstruction. J Bone Joint Surg Am 92:871–881

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  14. Milankov M, Savic D, Milojevic Z (2011) Geometric considerations regarding the surface of the tibial insertion of the ACL graft. Knee Surg Sports Traumatol Arthrosc, Letter to Editor, PMID: 22173731

  15. Odensten M, Gillquist J (1985) Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg Am 67:257–262

    PubMed  CAS  Google Scholar 

  16. Petersen W, Zantop T (2007) Anatomy of the anterior cruciate ligament with regard to its two bundles. Clin Orthop Relat Res 454:35–47

    Article  PubMed  Google Scholar 

  17. Sahasrabudhe A, Christel P, Anne F, Appleby D, Basdekis G (2010) Postoperative evaluation of tibial footprint and tunnels charecteristics characteristics after anatomic double-bundle anterior cruciate ligament reconstruction with anatomic aimers. Knee Surg Sports Traumatol Arthrosc 18:1599–1606

    Article  PubMed  Google Scholar 

  18. Siebold R, Ellert T, Metz S, Metz J (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 

  19. Siebold R, Zantop T (2009) Anatomic double-bundle ACL reconstruction: a call for indications. Knee Surg Sports Traumatol Arthrosc 17:211–212

    Article  PubMed  Google Scholar 

  20. Siebold R (2011) The concept of complete footprint restoration with guidelines for single- and double bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 19:699–706

    Article  PubMed  Google Scholar 

  21. Tállay Alim MH, Bartlett J (2008) Anatomical study of the human anterior cruciate ligament stump's tibial insertion footprint. Knee Surg Sports Traumatol Arthrosc 16:741–746

    Article  Google Scholar 

  22. van Eck CF, Lesniak BP, Schreiber VM, Fu FH (2010) Anatomic single- and double-bundle anterior cruciate ligament reconstruction flowchart. Arthroscopy 26:258–268

    Article  PubMed  Google Scholar 

  23. van Eck CF, Schreiber VM, Liu TT, Fu FH (2010) The anatomic approach to primary, revision and augmentation anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1154–1163

    Article  PubMed  Google Scholar 

  24. Zantop T, Petersen W, Sekiya JK, Musahl V, Fu FH (2006) ACL anatomy and function relating to anatomical reconstruction. Knee Surg Sports Traumatol Arthrosc 14:982–992

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. ATOS Klinik, Center for Hip- Knee- and Foot Surgery, Sportstraumatology, Bismarckstr. 9–15, 69115, Heidelberg, Germany

    Rainer Siebold & Peter Schuhmacher

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  1. Rainer Siebold
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  2. Peter Schuhmacher
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Correspondence to Rainer Siebold.

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Siebold, R., Schuhmacher, P. Restoration of the tibial ACL footprint area and geometry using the Modified Insertion Site Table. Knee Surg Sports Traumatol Arthrosc 20, 1845–1849 (2012). https://doi.org/10.1007/s00167-012-1899-4

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  • DOI: https://doi.org/10.1007/s00167-012-1899-4

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