Purpose: The purpose of this study was to measure the detailed morphology of the femoral anterior cruciate ligament (ACL) footprint. The correlation and the comparison between the measured area and the area which mathematically calculated as elliptical were also evaluated.
Materials and methods: Thirty nine nonpaired human cadaver knees were used. The ACL was cut in the middle, and the femoral bone was cut at the most proximal point of the femoral notch. The ACL was carefully dissected, and the periphery of the ACL insertion site was outlined on both the whole footprint and the midsubstance insertion. Lateral view of the femoral condyle was photographed with a digital camera, and the images were downloaded to a personal computer. The area, length, and width of the femoral ACL footprint were measured with Image J software (National Institution of Health). Using the length and width of the femoral ACL footprint, the elliptical area was calculated as 0.25 π (length × width). Statistical analysis was performed to reveal the correlation and the comparison of the measured and elliptically calculated area.
Results: The sizes of the whole and midsubstance femoral ACL footprints were 127.6 ± 41.7 mm2 and 61 ± 20.2 mm2, respectively. The sizes of the elliptically calculated whole and midsubstance femoral ACL footprints were 113.9 ± 4.5 mm2 and 58.4 ± 3 mm2, respectively. Significant difference was observed between the measured and the elliptically calculated area. In the midsubstance insertion, significant correlation was observed between the measured and the elliptically calculated area (Pearson's correlation coefficient = 0.603, P = 0.001). However, no correlation was observed in the whole ACL insertion area.
Conclusion: The morphology of the femoral ACL insertion resembles an elliptical shape. However, due to the wide variation in morphology, the femoral ACL insertion cannot be considered mathematically elliptical.
Keywords: Anatomy; anterior cruciate ligament; elliptical; femoral.
Copyright: © 2019 Indian Journal of Orthopaedics.
Conflict of interest statement
There are no conflicts of interest.
Proportional Evaluation of Anterior Cruciate Ligament Footprint Size and Knee Bony MorphologyT Iriuchishima et al. Knee Surg Sports Traumatol Arthrosc 23 (11), 3157-62. PMID 24951954.For clinical relevance, the femoral ACL footprint is approximately 18 %, the size of the intercondylar notch, and the tibial ACL footprint is approximately 6 %, the size …
Size Correlation Between the Tibial Anterior Cruciate Ligament Footprint and the Tibia PlateauT Iriuchishima et al. Knee Surg Sports Traumatol Arthrosc 23 (4), 1147-52. PMID 24610536.For clinical relevance, the AP length of lateral facet of the tibia plateau and total area of tibia plateau are significantly correlated with the size of the tibial ACL f …
The Correlation Between the Femoral Anterior Cruciate Ligament Footprint Area and the Morphology of the Distal Femur: Three-Dimensional CT Evaluation in Cadaveric KneesM Suruga et al. Eur J Orthop Surg Traumatol 29 (4), 849-854. PMID 30701307.Morphological evaluation using 3D-CT preoperatively may be useful in predicting the femoral ACL footprint size.
Medial Portal Drilling: Effects on the Femoral Tunnel Aperture Morphology During Anterior Cruciate Ligament ReconstructionD Hensler et al. J Bone Joint Surg Am 93 (22), 2063-71. PMID 22262377. - ReviewThe drill-bit diameter, transverse drill angle, and knee flexion angle can all affect femoral tunnel aperture morphology in medial portal drilling during ACL reconstructi …
A Systematic Review of Anterior Cruciate Ligament Femoral Footprint Location Evaluated by Quadrant Method for Single-Bundle and Double-Bundle Anatomic ReconstructionH Xu et al. Arthroscopy 32 (8), 1724-34. PMID 27140814. - ReviewCombined data unravel the standard position of ACL femoral origin. It can be used by clinicians to localize anatomic tunnel both in surgery and postsurgical evaluation. F …
- Fu FH. Double-bundle ACL reconstruction. Orthopedics. 2011;34:281–3. - PubMed
- Iriuchishima T, Shirakura K, Yorifuji H, Aizawa S, Murakami T, Fu FH, et al. ACL footprint size is correlated with the height and area of the lateral wall of femoral intercondylar notch. Knee Surg Sports Traumatol Arthrosc. 2013;21:789–96. - PubMed
- Kopf S, Musahl V, Tashman S, Szczodry M, Shen W, Fu FH, et al. A systematic review of the femoral origin and tibial insertion morphology of the ACL. Knee Surg Sports Traumatol Arthrosc. 2009;17:213–9. - PubMed
- Kopf S, Pombo MW, Szczodry M, Irrgang JJ, Fu FH. Size variability of the human anterior cruciate ligament insertion sites. Am J Sports Med. 2011;39:108–13. - PubMed
- Muneta T, Koga H, Mochizuki T, Ju YJ, Hara K, Nimura A, et al. A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy. 2007;23:618–28. - PubMed