Anterior cruciate ligament tibial insertion site is elliptical or triangular shaped in healthy young adults: high-resolution 3-T MRI analysis

Knee Surg Sports Traumatol Arthrosc. 2018 Feb;26(2):485-490. doi: 10.1007/s00167-017-4607-6. Epub 2017 Jun 24.


Purpose: To clarify the morphology of anterior cruciate ligament (ACL) tibial insertion site in healthy young knees using high-resolution 3-T MRI.

Methods: Subjects were 50 ACL-reconstructed patients with a mean age of 21.4 ± 6.8 years. The contralateral healthy knees were scanned using high-resolution 3-T MRI. The tibial insertion sites of the anteromedial (AM) and posterolateral (PL) bundle fibres, and the ACL attachment on the anterior horn of lateral meniscus (AHLM) were segmented from the MR images, and 3D models were reconstructed to evaluate the morphology. The shape of ACL footprint was qualitatively analysed, and the size of AM and PL attachments and AHLM overlapped area was measured digitally.

Results: Tibial AM and PL bundles were clearly identified in 42 of 50 knees (84.0%). Morphology of the whole ACL tibial insertion site was elliptical in 23 knees (54.8%) and triangular in 19 knees (45.2%), but not classified as C-shape in any knees. However, the AM bundle attachment was of C-shape in 29 knees (69.0%) and band-like in 13 knees (31.0%). Overlap of ACL on AHLM was found in 26 knees (61.9%), and the size of the overlapped area was 4.8 ± 4.7% of the whole ACL insertion site.

Conclusion: 3D morphology of the intact ACL tibial insertion site analysed by high-resolution 3-T MRI was elliptical or triangular in healthy young knees. However, the AM bundle insertion site was of C-shape or band-like. A small lateral portion of the ACL was overlapped with the AHLM. As for clinical relevance, these findings should be considered in order to reproduce the native ACL insertion site sufficiently.

Level of evidence: III.

Keywords: Anterior cruciate ligament; Footprint; High-resolution; MRI; Morphology; Tibial insertion site; Young.

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament / diagnostic imaging*
  • Anterior Cruciate Ligament Injuries / surgery
  • Anterior Cruciate Ligament Reconstruction
  • Female
  • Humans
  • Imaging, Three-Dimensional
  • Knee Joint / anatomy & histology
  • Knee Joint / diagnostic imaging
  • Knee Joint / surgery
  • Magnetic Resonance Imaging
  • Male
  • Tibia / anatomy & histology
  • Tibia / diagnostic imaging*
  • Tibia / surgery
  • Young Adult