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Knee Surgery, Sports Traumatology, Arthroscopy

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01.10.2006 | Knee

Anterior cruciate ligament anatomy and function relating to anatomical reconstruction

verfasst von: Thore Zantop, Wolf Petersen, Jon K. Sekiya, Volker Musahl, Freddie H. Fu

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 10/2006

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Abstract

Recently, the interest in surgical techniques that reconstruct the anteromedial (AM) and the posterolateral (PL) bundles of the anterior cruciate ligament (ACL) has risen. This review focuses on the structural as well as the mechanical properties of the ACL and the anatomical details of the femoral origin, midsubstance, and tibial insertion of AM and PL bundles of the ACL. The terminology of AM and PL bundles is chosen according to the tibial insertion and determined by their functional tensioning pattern throughout knee flexion. Close to extension the AM is moderately loose and the PL is tight. As the knee is flexed, the femoral attachment of the ACL becomes more horizontally oriented, causing the AM bundle to tighten and the PM bundle to loosen up. The ACL has been described to be restraint to anterior tibial displacement and internal tibial rotation. The rotational component might be represented by the PL bundle. The femoral origin has an oval shape with the center of the AM close to over-the-top position and the center of the PL close to the anterior and inferior cartilage margin. Tibial and femoral insertions of the ACL are over 3.5 times larger when compared to the midsubstance and tunnel placement is more challenging because of the limited size of potential grafts selection of tunnel site placement. For reconstruction, both bone–patellar tendon–bone (BPTB) and quadrupled hamstring grafts are used. Structural properties of a 10 mm wide BPTB or quadrupled hamstring graft have been reported to be comparable with those of the native ACL.

Adachi N, Ochi M, Uchio Y, Iwasa J, Kuriwaka M, Ito Y (2004) Reconstruction of the anterior cruciate ligament. Single- versus double-bundle multistranded hamstring tendons. J Bone Joint Surg Br 86(4):515–520PubMed

American Board of Orthopaedic Surgery (2004) Research committee report. Diplomatic Newsletter. ABOS, Chapel Hill, p 8

Amis AA, Dawkins GP (1991) Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. J Bone Joint Surg Br 73(2):260–267PubMed

Andersen HN, Dyhre-Poulsen P (1997) The anterior cruciate ligament does play a role in controlling axial rotation in the knee. Knee Surg Sports Traumatol Arthrosc 5(3):145–149PubMedCrossRef

Anderson AF, Dome DC, Gautam S, Awh MH, Rennirt GW (2001) Correlation of anthropometric measurements, strength, anterior cruciate ligament size, and intercondylar notch characteristics to sex differences in anterior cruciate ligament tears. Am J Sports Med 29:58–63PubMed

Arnoczky SP (1983) Anatomy of the anterior cruciate ligament. Clin Orthop 172:19–25PubMed

Arnoczky SP, Rubin RM, Marshall JL (1979) Microvasculature of the cruciate ligaments and its response to injury. J Bone Joint Surg Am 61:1221–1229PubMed

Bach JM, Hull HL, Patterson HA (1997) Direct measurements of strain in the posterolateral bundle of the anterior cruciate ligament. J Biomech 30:281–283PubMedCrossRef

Bellier G, Christel P, Colombet P, Djian P, Franceschi JP, Sbihi A (2004) Double-stranded hamstring graft for anterior cruciate ligament reconstruction. Arthroscopy 20:890–894PubMed

10.

Bernard M, Hertel P, Hornung H, Cierpinski T (1997) Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 10(1):14–21PubMed

11.

Brantigan OC, Voshell AF (1941) The mechanics of the ligaments and menisci of the knee joint. J Bone Joint Surg 23:44–66

12.

Butler DL, Noyes FR, Grood ES (1980) Ligamentous restraints to anterior–posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am 62(2):259–270PubMed

13.

Cha PS, Brucker PU, West RV, Fu FH (2005) Arthroscopic double bundle anterior cruciate ligament reconstruction: an anatomic approach. Arthroscopy (in press)

14.

Dienst M, Burks RT, Greis PE (2002) Anatomy and biomechanics of the anterior cruciate ligament. Orthop Clin North Am 33(4):605–620PubMedCrossRef

15.

Eriksson E (2003) Does ACL reconstruction restore normal tibial rotation? Knee Surg Sports Traumatol Arthrosc 11(6):359PubMedCrossRef

16.

Fleming BC, Renstrom PA, Beynnon BD, Engstrom B, Peura GD, Badger GJ, Johnson RJ (2001) The effect of weightbearing and external loading on anterior cruciate ligament strain. J Biomech 34:163–170PubMedCrossRef

17.

Fu FH, Bennett CH, Lattermann C, Ma CB (1999) Current trends in anterior cruciate ligament reconstruction. Part I: biology and biomechanics of reconstruction. Am J Sports Med 27:821–830PubMed

18.

Fukubayashi T, Torzilli PA, Sherman MF, Warren RF (1982) An in vitro biomechanical evaluation of anterior–posterior motion of the knee. Tibial displacement, rotation, and torque. J Bone Joint Surg Am 64(2):258–264PubMed

19.

Gabriel MT, Wong EK, Woo SL, Yagi M, Debski RE (2004) Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads. J Orthop Res 22(1):85–89PubMedCrossRef

20.

Girgis FG, Marshall JL, Monajem A (1975) The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clin Orthop 106:216–231PubMed

21.

Hamada M, Shino K, Horibe S, Mitsuoka T, Miyama T, Shiozaki T (2001) Single- versus bi-socket anterior cruciate ligament reconstruction using autogenous multiple-stranded hamstring tendons with endobutton femoral fixation: a prospective study. Arthroscopy 17:801–807PubMedCrossRef

22.

Hara K, Kubo T, Suginoshita T, Shimizu C, Hirasawa Y (2000) Reconstruction of the anterior cruciate ligament using a double bundle. Arthroscopy 16:860–864PubMedCrossRef

23.

Harner CD, Poehling GG (2004) Double bundle or double trouble? Arthroscopy 20(10):1013–1014PubMedCrossRef

24.

Harner CD, Baek GH, Vogrin TM, Carlin GJ, Kashiwaguchi S, Woo SL (1999) Quantitative analysis of human cruciate ligament insertions. Arthroscopy 15:741–749PubMedCrossRef

25.

Hefzy MS, Grood ES (1986) Sensitivity of insertion locations on length patterns of anterior cruciate ligament fibers. J Biomech Eng 108:73–82PubMedCrossRef

26.

Hollis JM, Takai S, Adams DJ (1991) The effects of knee motion and external loading on the length of the anterior cruciate ligament (ACL): a kinematic study. J Biomech Eng 113:208–214PubMed

27.

Howell SM (1998) Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 6(Suppl 1):S49–S55PubMedCrossRef

28.

Hutchinson MR, Ash SA (2003) Resident’s ridge: assessing the cortical thickness of the lateral wall and roof of the intercondylar notch. Arthroscopy 19(9):931–935PubMedCrossRef

29.

Jackson DW, Gasser SI (1994) Tibial tunnel placement in ACL reconstruction. Arthroscopy 10:124–131PubMedCrossRef

30.

Kennedy JC, Weinberg HW, Wilson AS (1974) The anatomy and function of the anterior cruciate ligament as determined by clinical and morphological studies. J Bone Joint Surg 56A:223–225

31.

Kummer B, Yamamoto M (1988) [Funktionelle Anatomie der Kreuzbaender]. Arthroskopie 1:2–10

32.

LaPrade RF, Burnett QM (1994) Femoral intercondylar notch stenosis and correlation to anterior cruciate ligament injuries. A prospective study. Am J Sports Med 22:198–202PubMed

33.

Lombardo S, Sethi PM, Starkey C (2004) Intercondylar notch stenosis is not a risk factor for anterior cruciate ligament tears in professional male basketball players: an 11-year prospective study. Am J Sports Med 33(1):29–34

34.

Marcacci M, Molgora AP, Zaffagnini S, Vascellari A, Iacono F, Presti ML (2003) Anatomic double-bundle anterior cruciate ligament reconstruction with hamstrings. Arthroscopy 19:540–546PubMedCrossRef

35.

Miller MD, Hinkin DT (1996) The “N + 7 rule” for tibial tunnel placement in endoscopic anterior cruciate ligament reconstruction. Arthroscopy 12:124–126PubMedCrossRef

36.

Morgan CD, Kalman VR, Grawl DM (1995) Definitive landmarks for reproducible tibial tunnel placement in anterior cruciate ligament reconstruction. Arthroscopy 11:275–288PubMedCrossRef

37.

Mott HW (1983) Semitendinosus anatomic reconstruction for cruciate ligament insufficiency. Clin Orthop 75:90–92

38.

Muneta T, Sekiya I, Yagishita K, Ogiuchi T, Yamamoto H, Shinomiya K (1999) Two-bundle reconstruction of the anterior cruciate ligament using semitendinosus tendon with endobuttons: operative technique and preliminary results. Arthroscopy 15:618–624PubMedCrossRef

39.

Musahl V, Burkart A, Debski RE, Van Scyoc A, Fu FH, Woo SL (2003) Anterior cruciate ligament tunnel placement: comparison of insertion site anatomy with the guidelines of a computer-assisted surgical system. Arthroscopy 19(2):154–160PubMedCrossRef

40.

Odensten M, Gillquist J (1985) Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg 67A:257–262

41.

Palmer I (1938) On the injuries to the ligaments of the knee joint: a clinical study. Acta Chir Scand 91:1–282

42.

Pederzini L, Adriani E, Botticella C, Tosi M (2000) Double tibial tunnel using quadriceps tendon in anterior cruciate ligament reconstruction. Arthroscopy 16:E9PubMedCrossRef

43.

Petersen W, Hansen U (1996) Blood supply of the anterior cruciate ligament. An immunohistochemical study in human cadavers. J Orthop Sci 5:332–334

44.

Petersen W, Laprell H (2000) Insertion of autologous tendon grafts to the bone: a histological and immunohistochemical study of hamstring and patellar tendon grafts. Knee Surg Sports Traumatol Arthrosc 8(1):26–31PubMedCrossRef

45.

Petersen W, Tillmann B (2002) [Anatomy and function of the anterior cruciate ligament]. Orthopade 31:710–718PubMedCrossRef

46.

Petersen W, Tillmann B (1999) Structure and vascularization of the cruciate ligaments of the human knee joint. Anat Embryol (Berl) 200(3):325–334CrossRef

47.

Pfab B (1927) [Zur Blutgefäßversorgung der Menisci und Kreuzbänder]. Dtsch Z Chir 205:258–264

48.

Reiman PR, Jackson DW (1987) Anatomy of the anterior cruciate ligament. In: Jackson DW, Drez D (eds) The anterior cruciate deficient knee. CV Mosby, St. Louis, pp 17–26

49.

Ristanis S, Giakas G, Papageorgiou CD, Moraiti T, Stergiou N, Georgoulis AD (2003) The effects of anterior cruciate ligament reconstruction on tibial rotation during pivoting after descending stairs. Knee Surg Sports Traumatol Arthrosc 11(6):360–365PubMedCrossRef

50.

Rosenberg TD, Graf B (2006) Techniques for ACL reconstruction with Multi-Trac drill guide. Acufex Microsurgical, Mansfield (in press)

51.

Sakane M, Fox RJ, Woo SL, Livesay GA, Li G, Fu FH (1997) In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res 15(2):285–293PubMedCrossRef

52.

Shelbourne KD, Facibene WA, Hunt JJ (1997) Radiographic and intraoperative intercondylar notch width measurements in men and women with unilateral and bilateral anterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc 5:229–233PubMedCrossRef

53.

Sommer C, Friederich NF, Muller W (2000) Improperly placed anterior cruciate ligament grafts: correlation between radiological parameters and clinical results. Knee Surg Sports Traumatol Arthrosc 8(4):207–213PubMedCrossRef

54.

Stäubli HU, Rauschning W (1994) 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. Knee Surg Sports Traumatol Arthrosc 2:138–146PubMedCrossRef

55.

Strocchi R, de Pasquale V, Gubellini P, Facchini A, Marcacci M, Buda R, Zaffagnini S, Ruggeri A (1992) The human anterior cruciate ligament: histological and ultrastructural observations. J Anat 180:515–519PubMed

56.

Takagi K (1939) The arthroscope. J Jpn Orthop Assoc 14:359–441

57.

Takai S, Woo SL-Y, Livesay GA (1993) Determination of the in situ loads on the human anterior cruciate ligament. J Orthop Res 11:686–695PubMedCrossRef

58.

Takeuchi R, Saito T, Mituhashi S, Suzuki E, Yamada I, Koshino T (2002) Double-bundle anatomic anterior cruciate ligament reconstruction using bone–hamstring–bone composite graft. Arthroscopy 18:550–555PubMedCrossRef

59.

Tashman S, Collon D, Anderson K, Kolowich P, Anderst W (2004) Abnormal rotational knee motion during running after ACL reconstruction. Am J Sports Med 32:975–983PubMedCrossRef

60.

Weiler A, Hoffmann RF, Bail HJ, Rehm O, Sudkamp NP (2002) Tendon healing in a bone tunnel. Part II: histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. Arthroscopy 18(2):124–135PubMedCrossRef

61.

Wilson TW, Zafuta MP, Zobitz M (1999) A biomechanical analysis of matched bone–patellar tendon–bone and double looped semitendinosus and gracilis tendon grafts. Am J Sports Med 27:202–207PubMed

62.

Woo SL, Hollis JM, Adams DJ, Lyon RM, Takai S (1991) Tensile properties of the human femur–anterior cruciate ligament–tibia complex. The effects of specimen age and orientation. Am J Sports Med 19(3):217–225PubMed

63.

Woo SL, Gomez MA, Seguchi Y, Endo CM, Akeson WH (1983) Measurement of mechanical properties of ligament substance from a bone–ligament–bone preparation. J Orthop Res 1:22–29PubMedCrossRef

64.

Woo SL, Kanamori A, Zeminski J, Yagi M, Papageorgiou C, Fu FH (2002) The effectiveness of reconstruction of the anterior cruciate ligament with hamstrings and patellar tendon. A cadaveric study comparing anterior tibial and rotational loads. J Bone Joint Surg Am 84-A(6):907–914PubMed

65.

Yasuda K, Kondo E, Ichiyama H, Kitamura N, Tanabe Y, Tohyama H, Minami A (2004) Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy 20:1015–1025PubMedCrossRef

66.

Zaffagnini S, Martelli S, Acquaroli F (2004) Computer investigation of ACL orientation during passive range of motion. Comput Biol Med 34(2):153–163PubMedCrossRef

67.

Zantop T, Brucker PU, Vidal A, Zelle BA, Fu FH (2006) Rupture pattern of the ACL. Clin Orthop Relat Res (submitted)

68.

Zaricznyj B (1987) Reconstruction of the anterior cruciate ligament of the knee using a doubled tendon graft. Clin Orthop 220:162–175PubMed

69.

Zavras TD, Race A, Amis AA (2004) The effect of femoral attachment location on anterior cruciate ligament reconstruction: graft tension patterns and restoration of normal anterior–posterior laxity patterns. Knee Surg Sports Traumatol Arthrosc 13(2):92–100 (Epub 10 December 2004)

Titel: Anterior cruciate ligament anatomy and function relating to anatomical reconstruction
verfasst von: Thore Zantop
Wolf Petersen
Jon K. Sekiya
Volker Musahl
Freddie H. Fu
Publikationsdatum: 01.10.2006
Verlag: Springer-Verlag
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 10/2006
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-006-0076-z

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