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ACL reconstruction and the implication of its tibial attachment for stability of the joint: anthropometric and biomechanical study

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Abstract

The planar topography of the anterior cruciate ligament (ACL) insertion was investigated and correlated to the use of the double-bundle/double tibial tunnel ACL reconstruction technique within the ACL tibial insertion area. The anteroposterior and mediolateral length of the tibial ACL attachment and the distances of the tibial insertion area from the anterior and posterior tibial borders were measured and the stability of the joint was tested using the double-bundle/double tibial tunnel ACL reconstruction technique. The anteroposterior length, 19.54 mm in men and 17.36 mm in women, of the ACL insertion, averaged approximately 40% of the total intercondylar anteroposterior dimension of the plateau. This broad distribution of insertion fibres ensures ligament tension and hence joint stability. The reported anteroposterior broad insertion of ACL fibres to the tibia is not sufficiently reproduced by the use of one or more bundles having a common tibial tunnel for the ACL reconstruction. In our view, this might be better achieved with two different bundles, with separate tunnels, and independent tensioning in different knee angles. This technique might achieve better results in human knee stability as opposed to other reported techniques.

Résumé

Une étude topographique de l’insertion du ligament croisé antérieur a recherchée une corrélation avec la technique du double tunnel/ double brin au niveau de la zone d’insertion tibiale. Les dimensions antéro-postérieure et médio-latérale de l’insertion tibiale ainsi que les distances entre les bords antérieur et postérieur du tibia et cette zone d’insertion étaient étudiées. La stabilité articulaire était testée après reconstruction par la technique du double brin avec double tunnel. La longueur antéro-postérieure de l’insertion - 19,54 mm chez l’homme et 17,36 chez la femme - représente approximativement 40% de la dimension antéro-postérieure du plateau tibial dans la région inter-condylienne. Cette distribution étendue de l’insertion des fibres assure la tension ligamentaire et en conséquence la stabilité articulaire. Cette insertion étendue n’est pas reproduite par l’utilisation d’un ou plusieurs brins passés dans un seul tunnel tibial. Nous pensons que cela peut être atteint en utilisant 2 brins et 2 tunnels avec une mise en tension indépendante dans les différentes positions du genou. Cette technique devrait donner de meilleurs résultats que les techniques habituellement proposées.

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Authors and Affiliations

  1. 2nd Department of Orthopaedics, University of Athens, Constantopoulion Hospital, N. Ionia, Greece

    George Papachristou, John Sourlas, Evangelos Magnissalis, Spyros Plessas & Konstantinos Papachristou

  2. 4 Moschopoleos Street, 156 69, Papagou, Athens, Greece

    George Papachristou

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  1. George Papachristou
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  2. John Sourlas
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  3. Evangelos Magnissalis
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  4. Spyros Plessas
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  5. Konstantinos Papachristou
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Correspondence to George Papachristou.

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Papachristou, G., Sourlas, J., Magnissalis, E. et al. ACL reconstruction and the implication of its tibial attachment for stability of the joint: anthropometric and biomechanical study. International Orthopaedics (SICO 31, 465–470 (2007). https://doi.org/10.1007/s00264-006-0213-9

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  • DOI: https://doi.org/10.1007/s00264-006-0213-9

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