Abstract
Graft placement in cruciate ligament reconstruction is known to significantly influence postoperative knee stability and range of motion. Improvement of bone tunnel positioning has been advocated by computer-assisted surgical procedures that require reliable input and reference data. This study validates the hypothesis that morphometric reference data can be obtained from the uninjured controlateral knee for accurate bone tunnel and graft positioning. Thirty pairs of human cadaver knees were dissected and the femoral and tibial footprints of the anterior and posterior cruciate ligaments (PCL) were radiopaquely marked. Radiographs were taken of the corresponding left- and right-sided femora and tibiae, and digitally processed. Controlateral specimens were mirrored and overlapped precisely, the areas and intersections of ligament insertion were digitally determined. There were no significant differences in the total area of cruciate ligament insertion between left and right knee specimens or between female and male specimens. Intersection areas (IAs) in femoral and tibial anterior cruciate ligament (ACL) insertions averaged 31.3 and 33.4% of the total insertion area, respectively. The center of gravity for the femoral and tibial ACL footprint differed by 4.7 and 4.5 mm between left and right knees, respectively. IAs in femoral and tibial PCL insertions averaged 46.1 and 61.3% of the total insertion area, respectively. The center of gravity for the femoral and tibial PCL footprint differed by 4.5 and 2.4 mm between left and right knees, respectively. Our study does not support the concept of obtaining morphologic reference data from the uninjured controlateral knee for individual bone tunnel placement.
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References
Arnoczky SP (1983) Anatomy of the anterior cruciate ligament. Clin Orthop Relat Res 172:19–25
Clarke HD, Scott WN, Insall JN, Pedersen HB, Math KR, Vigorita VJ, Cushner FD (2001) Anatomy. In: Insall JN, Scott WN (eds) Surgery of the knee. Churchill Livingston, New York, pp 13–76
Csizy M, Friederich NF (2002) Bohrkanalposition in der operativen Rekonstruktion des vorderen Kreuzbandes. Orthopäde 31:741–750
Friederich NF, O´Brien WR (1990) Zur funktionellen Anatomie der Kreuzbänder. In: Jakob RP, Stäubli HU (eds) Kniegelenk und Kreuzbänder. Springer, Berlin Heidelberg New York, pp 80–95
Furman W, Marshall JL, Girgis FG (1976) The anterior cruciate ligament. J Bone Joint Surg 58A:179–185
Fuss FK (1989) Anatomy of the cruciate ligament and their function in extension and flexion of the human knee joint. Am J Anat 184:165–176
Girgis FG, Marsahll JL, Al Monajem ARS (1975) The cruciate ligaments of the knee joint. Clin Orthop Relat Res 106:216–231
Grood ES (1992) Placement of knee ligament grafts. In: Aichroth PM, Cannon WD, Patel DV (eds) Knee surgery, current practice. Martin Duniz, London, pp 116–129
Harner CD, Xerogeanes JW, Livesay GA, Carlin GJ, Smith BA, Kusayama T, Kashiwaguchi S, Woo SLY (1995) The human posterior cruciate ligament complex: an interdisciplinary study. Am J Sports Med 23:736–745
Harner CD, Baek GH, Vogrin TM, Carlin GJ, Kashiwaguchi S, Woo SLY (1999) Quantitative analysis of human cruciate ligament insertions. Arthroscopy 15:741–749
Hefzy MS, Grood ES, Noyes FR (1989) Factors affecting the region of most isometric femoral attachments. Am J Sports Med 17:208–216
Julliard R, Lavallee S, Dessenne V (1998) Computer assisted reconstruction of the anterior cruciate ligament. Clin Orthop Relat Res 354:57–64
Markolf KL, Hame S, Hunter DM, Oakes DA, Zoric B, Gause P, Finerman GA (2002) Effects of femoral tunnel placement on knee laxity and forces in an anterior cruciate ligament graft. J Orthop Res 20:1016–1024
Mommersteeg TJA, Kooloos JGM, Blankevoort L, Kauer JM, Huiskes R, Roeling FQ (1995) The fibre bundle anatomy of human cruciate ligaments. J Anat 187:461–471
Morgan CD, Kalmam VR, Grawl DM (1995) Isometry testing for anterior cruciate ligament reconstruction revisited. Arthroscopy 11:647–659
Mueller W (1982) Das Knie. Springer, Berlin Heidelberg New York, pp 49–50
Musahl V, Burkart A, Debski RE, Van Scyoc A, Fu FH, Woo SL (2003) Anterior cruciate ligament tunnel placement: comparison of insertion site anatomy to the guidelines of a computer assisted surgical system. Arthroscopy 19:154–160
Musahl V, Plakseychuk A, VanScyoc A, Sasaki T, Debski RE, McMahon PJ, Fu FH (2005) Varying femoral tunnels between the anatomical footprint and isometric positions. Am J Sports Med 33:712–718
Odentsen M, Gillquist J (1985) Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg 67A:257–261
Petermann J, Kober R, Heinze R, Frölich JJ, Heeckt PF, Gotzen L (2000) Computer-assisted planning and robot-assisted surgery in anterior cruciate ligament reconstruction. Oper Orthop 10:50–55
Sati M, De Guise JA, Drouin G (1997) Computer assisted knee surgery: diagnostics and planning of knee surgery. Comput Aided Surg 2:108–123
Tomczak RJ, Hehl G, Mergo PJ, Merkle E, Rieber A, Brambs HJ (1997) Tunnel placement in anterior cruciate ligament reconstruction: MRI analysis as an important factor in the radiological report. Skeletal Radiol 26:409–413
van Dommelen BA, Fowler PJ (1989) Anatomy of the posterior cruciate ligament. Am J Sports Med 17:24–29
Zavras TD, Race A, Bull AM, Amis AA (2001) A comparative study of “isometric” points for anterior cruciate ligament graft attachment. Knee Surg Sports Traumatol Arthrosc 9:28–33
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Dargel, J., Pohl, P., Tzikaras, P. et al. Morphometric side-to-side differences in human cruciate ligament insertions. Surg Radiol Anat 28, 398–402 (2006). https://doi.org/10.1007/s00276-006-0107-y
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DOI: https://doi.org/10.1007/s00276-006-0107-y