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Tibial attachment area of the anterior cruciate ligament in the extended knee position

Anatomy and cryosections in vitro complemented by magnetic resonance arthrography in vivo

  • Clinical and Biomechanical Papers
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Knowledge of the anatomy of the anterior cruciate ligament (ACL), including its course and orientation in relation to the roof of the intercondylar fossa, is a prerequisite for successful intra-articular ACL reconstruction. To attain precision placement of the tibial attachment site and to avoid graft/roof conflict in the extended knee position, we assessed the anteroposterior tibial insertion of the ACL in the midsagittal plane of the extended knee. We measured the anterior-posterior (AP) limits and the center of the tibial attachment area of the ACL from the anterior tibial margin. The inclination angle of the intercondylar fossa roof was measured with respect to the shaft axis of the femur. The tibial attachment area of the ACL was determined in ten cadaveric knees. Using the cryoplaning technique, we determined the tibital attachment of the ACL in five knees. Using contrast magnetic resonance arthrography (MRA), we measured the tibial insertion of the ACL in 35 patients (23 male and 12 female) with intact ACLs. The total AP midsagittal diameter of the tibia averaged 51.0±5.8 mm in the cadaveric knees, 49 mm on cryosections, and 53.7 mm in men and 49.0 mm in women with MRA. The average anterior limit of the ACL, measured from the anterior tibial margin, was 14±4.2 mm in the cadaveric knees, 12.1 mm at cryosectional anatomy, and 15.2 mm in men and 13.4 mm in women with MRA. The center of the tibial attachment area was located at 21±2.6 mm in cadaveric knees, at 21.2 mm on cryosections, and at 23.7 mm in men and at 21.4 mm in women with MRA. The posterior limit of the tibial attachment area of the ACL was 29.0±4.1 mm in cadaveric knees, 30.6 mm on cryosections, 32.1 mm in male and 29.4 mm female patients with MRA. The roof inclination angle measured on average 39.8° on cryosections and 36.8° in men and 35.2° in women on MRA. Based on these morphometric data and to avoid notch/graft conflict in knee extension, we advocate placing the center of the tibial tunnel at 44% of the tibia diameter posterior and parallel to the individual intercondylar roof inclination angle.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Academic University Hospital, S-75185, Uppsala, Sweden

    W. Rauschning

  2. Department of Orthopaedics and Traumatology, Surgical Clinic Tiefenauspital, Tietenaustrasse 112, CH-3004, Bern, Switzerland

    H. -U. Stäubli

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  1. H. -U. Stäubli
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  2. W. Rauschning
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Stäubli, H.U., Rauschning, W. Tibial attachment area of the anterior cruciate ligament in the extended knee position. Knee Surg, Sports traumatol, Arthroscopy 2, 138–146 (1994). https://doi.org/10.1007/BF01467915

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  • DOI: https://doi.org/10.1007/BF01467915

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