ANATOMICAL RESEARCH OF TIBIAL INSERTION OF ANTERIOR CRUCIATE LIGAMENT IN CHINESE ADULTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YOUTian , ZHANGXintao ,  ZHANGWentao , JIANGChangqing , HUANGWei , LIWei , ZHANGHonglei , BAILu , JIANGXiaocheng , ZUOJianwei , CHENPeng , RENShiyou

Department of Sports Medicine and Rehabilitation, Peking University Shenzhen Hospital, Shenzhen Guangdong, 518036, P. R. China;

Corresponding author：

ZHANGWentao, Email: 17914@163.com

Keywords：

Anterior cruciate ligament; Tibial insertion; Anatomical research

DOI：

10.7507/1002-1892.20150157

Video：

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Objective To observe the anatomical morphology of the tibial insertion of the anterior cruciate ligament (ACL) in Chinese adults so as to offer theoretical guidance for ACL reconstruction and meniscus transplantation. Methods Fifteen adult cadaveric knees (8 left knees and 7 right knees) were dissected, including 10 males and 5 females, with an age ranged from 25 to 47 years (mean, 32.4 years). All knees were generally observed through standard medial parapatellar approaches, then the ACL midsubstance and the tibial insertion (direct and indirect insertions) were anatomically measured. Results In all specimens, the ACL was flat with a lot of fine fibers. The anteromedial bundle and posterolateral bundle could be observed in 13 of 15 knees. However, no obvious bundles were found in 2 knees. The arc-shaped tibial direct insertion started at the medial tibial eminence and ended at the anterior horn of the lateral meniscus. The width of the arc was (11.2±2.4) mm; the thickness was (3.0±0.3) mm; and the cross-sectional area was (28.8±7.8) mm². And the left-right diameter of the whole insertion was (9.5±1.8) mm; anteroposterior diameter was (11.9±0.6) mm; and the cross-sectional area was (117.8±12.5) mm². The width of the anterior horn of lateral meniscus was (12.3±2.0) mm. The anterior horn of lateral meniscus was surrounded by arc-shaped direct insertion in the middle, and its fibers were partly intertwined with indirect insertion of ACL. Conclusion Anatomical ACL reconstruction may therefore require a arc-shaped tibial footprint. There are overlap covering relationship between the attachment location of anterior horn of the lateral meniscus and tibial insertion of ACL. It should pay more attention to protecting tibial insertion of ACL in lateral meniscus transplantation.

Citation： YOUTian, ZHANGXintao, ZHANGWentao, JIANGChangqing, HUANGWei, LIWei, ZHANGHonglei, BAILu, JIANGXiaocheng, ZUOJianwei, CHENPeng, RENShiyou. ANATOMICAL RESEARCH OF TIBIAL INSERTION OF ANTERIOR CRUCIATE LIGAMENT IN CHINESE ADULTS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(6): 730-733. doi: 10.7507/1002-1892.20150157 Copy

1.	Siebold R, Schuhmacher P, Fernandez F, et al. Flat midsubstance of the anterior cruciate ligament with tibial "C"-shaped insertion site. Knee Surg Sports Traumatol Arthrosc, 2014.[Epub ahead of print].
2.	Ferretti M, Doca D, Ingham SM, et al. Bony and soft tissue landmarks of the ACL tibial insertion site:an anatomical study. Knee Surg Sports Traumatol Arthrosc, 2012, 20(1):62-68.
3.	Sadoghi P, Borbas P, Friesenbichler J, et al. Evaluating the tibial and femoral insertion site of the anterior cruciate ligament using an objective coordinate system:a cadaver study. Injury, 2012, 43(10):1771-1775.
4.	Adachi N, Ochi M, Uchio Y, et al. Reconstruction of the anterior cruciate ligament. Single-versus double-bundle multistranded hamstring tendons. J Bone Joint Surg (Br), 2004, 86(4):515-520.
5.	Buoncristiani AM, Tjoumakaris FP, Starman JS, et al. Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy, 2006, 22(9):1000-1006.
6.	Edwards A, Bull AM, Amis AA. The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament:Part 1:tibial attachment. Knee Surg Sports Traumatol Arthrosc, 2007, 15(12):1414-1421.
7.	Fu FH, Karlsson J. A long journey to be anatomic. Knee Surg Sports Traumatol Arthrosc, 2010, 18(9):1151-1153.
8.	Luites JW, Wymenga AB, Blankevoort L, et al. Description of the attachment geometry of the anteromedial and posterolateral bundles of the ACL from arthroscopic perspective for anatomical tunnel placement. Knee Surg Sports Traumatol Arthrosc, 2007, 15(12):1422-1431.
9.	Siebold R, Ellert T, Metz S, et al. Tibial insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament:morphometry, arthroscopic landmarks, and orientation model for bone tunnel placement. Arthroscopy, 2008, 24(2):154-161.
10.	Siebold R, Schuhmacher P. Restoration of the tibial ACL footprint area and geometry using the modified insertion site table. Knee Surg Sports Traumatol Arthrosc, 2012, 20(9):1845-1849.
11.	Yasuda K, Kondo E, Ichiyama H, et al. Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy, 2004, 20(10):1015-1025.
12.	Otsubo H, Shino K, Suzuki D, et al. The arrangement and the attachment areas of three ACL bundles. Knee Surg Sports Traumatol Arthrosc, 2012, 20(1):127-134.
13.	Dargel J, Pohl P, Tzikaras P, et al. Morphometric side-to-side differences in human cruciate ligament insertions. Surg Radiol Anat, 2006, 28(4):398-402.
14.	Duthon VB, Barea C, Abrassart S, et al. Anatomy of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc, 2006, 14(3):204-213.
15.	Ferretti M, Levicoff EA, Macpherson TA, et al. The fetal anterior cruciate ligament:an anatomic and histologic study. Arthroscopy, 2007, 23(3):278-283.
16.	Hashemi J, Mansouri H, Chandrashekar N, et al. Age, sex, body anthropometry, and ACL size predict the structural properties of the human anterior cruciate ligament. J Orthop Res, 2011, 29(7):993-1001.
17.	Iriuchishima T, Yorifuji H, Aizawa S, et al. Evaluation of ACL mid-substance cross-sectional area for reconstructed autograft selection. Knee Surg Sports Traumatol Arthrosc, 2012, 22(1):207-213.
18.	陈连旭, 余家阔, 敖英芳, 等. 前交叉韧带止点形态学测量及重建骨道直径探讨. 中国运动医学杂志, 2011, 30(5):432-436.
19.	Siebold R, Ellert T, Metz S, et al. Tibial insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament:morphometry, arthroscopic landmarks, and orientation model for bone tunnel placement. Arthroscopy, 2008, 24(2):154-161.
20.	Harner CD, Baek GH, Vogrin TM, et al. Quantitative analysis of human cruciate ligament insertions. Arthroscopy, 1999, 15(7):741-749.
21.	Iwahashi T, Shino K, Nakata K, et al. Direct anterior cruciate ligament insertion to the femur assessed by histology and 3-dimensional volume-rendered computed tomography. Arthroscopy, 2010, 26(9 Suppl):S13-S20.
22.	Mochizuki T, Fujishiro H, Nimura A, et al. Anatomic and histologic analysis of the mid-substance and fan-like extension fibres of the anterior cruciate ligament during knee motion, with special reference to the femoral attachment. Knee Surg Sports Traumatol Arthrosc, 2014, 22(2):336-344.
23.	Sasaki N, Ishibashi Y, Tsuda E, et al. The femoral insertion of the anterior cruciate ligament:discrepancy between macroscopic and histological observations. Arthroscopy, 2012, 28(8):1135-1146.
24.	章亚东, 侯树勋, 张轶超, 等. 关节镜下同种异体半月板移植的疗效分析. 中华骨科杂志, 2010, 30(2):175-181.
25.	冯华, 张辉, 洪雷, 等. 半月板移植的早期临床疗效分析. 中华骨科杂志, 2010, 30(4):351-356.
26.	张文涛, 张新涛, 黄伟. 同种异体半月板移植治疗盘状半月板撕裂. 中国修复重建外科杂志, 2011, 25(3):272-274.

1. Siebold R, Schuhmacher P, Fernandez F, et al. Flat midsubstance of the anterior cruciate ligament with tibial "C"-shaped insertion site. Knee Surg Sports Traumatol Arthrosc, 2014.[Epub ahead of print].
2. Ferretti M, Doca D, Ingham SM, et al. Bony and soft tissue landmarks of the ACL tibial insertion site:an anatomical study. Knee Surg Sports Traumatol Arthrosc, 2012, 20(1):62-68.
3. Sadoghi P, Borbas P, Friesenbichler J, et al. Evaluating the tibial and femoral insertion site of the anterior cruciate ligament using an objective coordinate system:a cadaver study. Injury, 2012, 43(10):1771-1775.
4. Adachi N, Ochi M, Uchio Y, et al. Reconstruction of the anterior cruciate ligament. Single-versus double-bundle multistranded hamstring tendons. J Bone Joint Surg (Br), 2004, 86(4):515-520.
5. Buoncristiani AM, Tjoumakaris FP, Starman JS, et al. Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy, 2006, 22(9):1000-1006.
6. Edwards A, Bull AM, Amis AA. The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament:Part 1:tibial attachment. Knee Surg Sports Traumatol Arthrosc, 2007, 15(12):1414-1421.
7. Fu FH, Karlsson J. A long journey to be anatomic. Knee Surg Sports Traumatol Arthrosc, 2010, 18(9):1151-1153.
8. Luites JW, Wymenga AB, Blankevoort L, et al. Description of the attachment geometry of the anteromedial and posterolateral bundles of the ACL from arthroscopic perspective for anatomical tunnel placement. Knee Surg Sports Traumatol Arthrosc, 2007, 15(12):1422-1431.
9. Siebold R, Ellert T, Metz S, et al. Tibial insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament:morphometry, arthroscopic landmarks, and orientation model for bone tunnel placement. Arthroscopy, 2008, 24(2):154-161.
10. Siebold R, Schuhmacher P. Restoration of the tibial ACL footprint area and geometry using the modified insertion site table. Knee Surg Sports Traumatol Arthrosc, 2012, 20(9):1845-1849.
11. Yasuda K, Kondo E, Ichiyama H, et al. Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy, 2004, 20(10):1015-1025.
12. Otsubo H, Shino K, Suzuki D, et al. The arrangement and the attachment areas of three ACL bundles. Knee Surg Sports Traumatol Arthrosc, 2012, 20(1):127-134.
13. Dargel J, Pohl P, Tzikaras P, et al. Morphometric side-to-side differences in human cruciate ligament insertions. Surg Radiol Anat, 2006, 28(4):398-402.
14. Duthon VB, Barea C, Abrassart S, et al. Anatomy of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc, 2006, 14(3):204-213.
15. Ferretti M, Levicoff EA, Macpherson TA, et al. The fetal anterior cruciate ligament:an anatomic and histologic study. Arthroscopy, 2007, 23(3):278-283.
16. Hashemi J, Mansouri H, Chandrashekar N, et al. Age, sex, body anthropometry, and ACL size predict the structural properties of the human anterior cruciate ligament. J Orthop Res, 2011, 29(7):993-1001.
17. Iriuchishima T, Yorifuji H, Aizawa S, et al. Evaluation of ACL mid-substance cross-sectional area for reconstructed autograft selection. Knee Surg Sports Traumatol Arthrosc, 2012, 22(1):207-213.
18. 陈连旭, 余家阔, 敖英芳, 等. 前交叉韧带止点形态学测量及重建骨道直径探讨. 中国运动医学杂志, 2011, 30(5):432-436.
19. Siebold R, Ellert T, Metz S, et al. Tibial insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament:morphometry, arthroscopic landmarks, and orientation model for bone tunnel placement. Arthroscopy, 2008, 24(2):154-161.
20. Harner CD, Baek GH, Vogrin TM, et al. Quantitative analysis of human cruciate ligament insertions. Arthroscopy, 1999, 15(7):741-749.
21. Iwahashi T, Shino K, Nakata K, et al. Direct anterior cruciate ligament insertion to the femur assessed by histology and 3-dimensional volume-rendered computed tomography. Arthroscopy, 2010, 26(9 Suppl):S13-S20.
22. Mochizuki T, Fujishiro H, Nimura A, et al. Anatomic and histologic analysis of the mid-substance and fan-like extension fibres of the anterior cruciate ligament during knee motion, with special reference to the femoral attachment. Knee Surg Sports Traumatol Arthrosc, 2014, 22(2):336-344.
23. Sasaki N, Ishibashi Y, Tsuda E, et al. The femoral insertion of the anterior cruciate ligament:discrepancy between macroscopic and histological observations. Arthroscopy, 2012, 28(8):1135-1146.
24. 章亚东, 侯树勋, 张轶超, 等. 关节镜下同种异体半月板移植的疗效分析. 中华骨科杂志, 2010, 30(2):175-181.
25. 冯华, 张辉, 洪雷, 等. 半月板移植的早期临床疗效分析. 中华骨科杂志, 2010, 30(4):351-356.
26. 张文涛, 张新涛, 黄伟. 同种异体半月板移植治疗盘状半月板撕裂. 中国修复重建外科杂志, 2011, 25(3):272-274.

Chinese Journal of Reparative and Reconstructive Surgery

ANATOMICAL RESEARCH OF TIBIAL INSERTION OF ANTERIOR CRUCIATE LIGAMENT IN CHINESE ADULTS

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