Tibial insertion of the anterior cruciate ligament and anterior horn of the lateral meniscus share the lateral slope of the medial intercondylar ridge: A computed tomography study in a young, healthy population

The Knee ◽  
2019 ◽  
Vol 26 (3) ◽  
pp. 612-618 ◽  
Author(s):  
Yasukazu Yonetani ◽  
Masashi Kusano ◽  
Akira Tsujii ◽  
Kazutaka Kinugasa ◽  
Masayuki Hamada ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Anterior Horn ◽  
Healthy Population ◽  
Tibial Insertion ◽  
Anterior Cruciate

Tibial insertions of the anterior cruciate ligament and the anterior horn of the lateral meniscus: A histological and computed tomographic study

The Knee ◽  
2017 ◽  
Vol 24 (4) ◽  
pp. 782-791 ◽  
Author(s):  
Masashi Kusano ◽  
Yasukazu Yonetani ◽  
Tatsuo Mae ◽  
Ken Nakata ◽  
Hideki Yoshikawa ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Anterior Horn ◽  
Computed Tomographic ◽  
Anterior Cruciate

Anterior Cruciate Ligament Insertions on the Tibia and Femur and Their Relationships to Critical Bony Landmarks Using High-Resolution Volume-Rendering Computed Tomography

2008 ◽  
Vol 36 (11) ◽  
pp. 2083-2090 ◽  
Author(s):  
Mark L Purnell ◽  
Andrew I. Larson ◽  
William Clancy
Keyword(s):  
Computed Tomography ◽  
Anterior Cruciate Ligament ◽  
Volume Rendering ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Anterior Border ◽  
Tibial Eminence ◽  
Bony Landmarks ◽  
Tibial Condyle ◽  
Anterior Cruciate

Background Controversy exists regarding the locations of the anterior cruciate ligament insertions on the femur and tibia and visualization of these insertions during surgical reconstruction. Hypothesis Anatomical insertions of the anterior cruciate ligament have relationships to bony landmarks of the tibia and femur. Study Design Descriptive laboratory study. Methods Eight cadaveric knees were scanned by computed tomography, reconstructed 3-dimensionally, and examined from simulated arthroscopic, sagittal, and axial perspectives. Volume-rendering software was used to document the relationship of the anterior cruciate ligament to the bony anatomy. Results A bony ridge (Resident's Ridge) at the anterior border of the anterior cruciate ligament was readily noted on the medial wall of the lateral femoral condyle. Superiorly, anterior cruciate ligament fibers inserted up to the roof of the notch and to 3 to 3.5 mm of the articular surface posteriorly and interiorly. The anterior cruciate ligament inserted into a fovea anterior to the tibial eminence. Posteriorly, anterior cruciate ligament fibers inserted up to a ridge between the medial and lateral intercondylar tubercles. Medially, anterior cruciate ligament fibers inserted onto the ridge at the lateral border of the medial tibial condyle. There was no distinct anterior or lateral bony border with anterior cruciate ligament fibers blending into the anterior horn of the lateral meniscus. Conclusion The anterior border of the femoral anterior cruciate ligament origin is Resident's Ridge. The ridge between the medial and lateral intercondylar tubercles at the base of the tibial eminence is the posterior margin of the anterior cruciate ligament on the tibia. Clinical Relevance Bony landmarks can be used to aid in anatomical anterior cruciate ligament reconstruction.

Anatomic all-epiphysial tibial tunnels for anterior cruciate ligament reconstruction in skeletally immature knees may be placed without damaging the anterior meniscus root

2018 ◽  
Vol 3 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Kevin G Shea ◽  
Peter C Cannamela ◽  
Peter D Fabricant ◽  
Allen F Anderson ◽  
John D Polousky ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Lateral Meniscus ◽  
Spatial Relationship ◽  
Anterior Horn ◽  
Joint Surface ◽  
Skeletally Immature ◽  
Meniscus Root ◽  
Anterior Cruciate

ObjectivesThe purpose of this study was to evaluate the spatial relationship of the anterior horns of the menisci and the tibial tunnel during all-epiphysial drilling of skeletally immature specimens and identify any iatrogenic damage or destabilisation to the meniscus and meniscal root.MethodsFour skeletally immature cadaveric knee specimens (aged 9–11 years) were used to create three-dimensional models from CT images. All-epiphysial anterior cruciate ligament (ACL) tibial tunnel drilling was performed in 14 specimens (aged 7–11 years), entering the joint surface at the ACL footprint and avoided the proximal tibial physis. The anterior meniscal roots and horns were closely inspected visually and probed for stability, prior to drilling. After drilling, the meniscus and attachment points were re-evaluated for damage to the meniscus, meniscus root and probed to evaluate for destabilisation.ResultsAll-epiphysial tunnels entered the joint at the anatomic ACL tibial footprint. Direct visual inspection of the menisci demonstrated an absence of damage to either meniscus or anterior horn regions in all specimens. Probing and traction of the medial and lateral meniscal tissue did not demonstrate evidence of instability or destabilisation of the anterior horn or meniscus root before or after drilling. All tunnels were circumferentially intact at the joint surface, with no evidence of superior tunnel perforation due to shallow tunnel angle.ConclusionIn this study, tunnel placement did not produce damage to either meniscus, nor noticeably destabilise the meniscal roots. This study also demonstrated that drill holes can be placed within the ACL footprint without entering the joint on the proximal tibia surface anterior to the ACL attachment, although the ‘safe zone’ for drill hole placement is limited. All-epiphysial ACL tibial tunnels can create a large aperture at the tibial joint surface, but these tunnels can be placed at the anatomic footprint of the ACL, without causing gross anterior medial or lateral meniscus horn or root injury.

scholarly journals The Anatomic Centers of the Femoral and Tibial Insertions of the Anterior Cruciate Ligament: A Systematic Review of Imaging and Cadaveric Studies Reporting Normal Center Locations

2016 ◽  
Vol 45 (9) ◽  
pp. 2180-2188 ◽  
Author(s):  
Anagha P. Parkar ◽  
Miraude E.A.P.M. Adriaensen ◽  
Søren Vindfeld ◽  
Eirik Solheim
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Healthy Population ◽  
Tunnel Placement ◽  
Weighted Mean ◽  
Tibial Insertion ◽  
Weighted Means ◽  
Weighted Median ◽  
Anterior Cruciate

Background: The anterior cruciate ligament (ACL) is regularly reconstructed if knee joint function is impaired. Anatomic graft tunnel placement, often assessed with varying measurement methods, in the femur and tibia is considered important for an optimal clinical outcome. A consensus on the exact location of the femoral and tibial footprint centers is lacking. Purpose: To systematically review the literature regarding anatomic centers of the femoral and tibial ACL footprints and assess the mean, median, and percentiles of normal centers. Study Design: Systematic review. Methods: A systematic literature search was performed in the PubMed/Medline database in November 2015. Search terms were the following: “ACL” and “insertion anatomy” or “anatomic footprint” or “radiographic landmarks” or “quadrant methods” or “tunnel placement” or “cadaveric femoral” or “cadaveric tibial.” English-language articles that reported the location of the ACL footprint according to the Bernard and Hertel grid in the femur and the Stäubli and Rauschning method in the tibia were included. Weighted means, weighted medians, and weighted 5th and 95th percentiles were calculated. Results: The initial search yielded 1393 articles. After applying the inclusion and exclusion criteria, 16 studies with measurements on cadaveric specimens or a healthy population were reviewed. The weighted mean of the femoral insertion center based on measurements in 218 knees was 29% in the deep-shallow (DS) direction and 35% in the high-low (HL) direction. The weighted median was 26% for DS and 34% for HL. The weighted 5th and 95th percentiles for DS were 24% and 37%, respectively, and for HL were 28% and 43%, respectively. The weighted mean of the tibial insertion center in the anterior-posterior direction based on measurements in 300 knees was 42%, and the weighted median was 44%; the 5th and 95th percentiles were 39% and 46%, respectively. Conclusion: Our results show slight differences between the weighted means and medians in the femoral and tibial insertion centers. We recommend the use of the 5th and 95th percentiles when considering postoperative placement to be “in or out of the anatomic range.”

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