Skip to main content
SpringerLink
Log in

MRI analysis of the attachment of the anteromedial and posterolateral bundles of anterior cruciate ligament using coronal oblique images

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

Abstract

Purpose

The purpose of this study was to evaluate the course of the anteromedial bundle (AMB) and the posterolateral bundle (PLB) of the anterior cruciate ligament (ACL) with magnetic resonance imaging (MRI) in order to clarify the relationship between the bundles and surrounding anatomic landmarks.

Methods

Eighty-eight knees with intact ACLs were included in this study. MRI coronal oblique images were obtained with the knee in extension and used to assess the following characteristics of the AMB and PLB: (1) course of the ligament, (2) location of the tibial attachment, and (3) femoral attachment and geometry of the lateral femoral condyle inner wall.

Results

In terms of the tibial attachment, the AMB was confluent with the apex of the medial intercondylar ridge (MIR) in all cases. Sixty-five PLBs (74%) inserted into the region between the apex and the slope of the MIR. The resident’s ridge was detected in 91% of the knees in the AMB image, whereas the ridge was clearly visualized in only 17% of the knees in the PLB image. A bony eminence was observed at the inner articular margin of the lateral femoral condyle in the PLB image.

Conclusion

In terms of the tibial attachment, the AMB was confluent with the apex of the medial intercondylar ridge in all cases. Most of the PLBs attached to the region between the apex and the slope of the MIR. Because the bone tunnel location influences clearance between the grafts and the surrounding tissues, these results should be considered during anatomic double-bundle ACL reconstruction.

Level of evidence

Study of nonconsecutive patients without a universally applied gold standard, Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Amis AA, Jakob RP (1998) Anterior cruciate ligament graft positioning, tensioning and twisting. Knee Surg Sports Traumatol Arthrosc 6:S2–S12

    Article  PubMed  Google Scholar 

  2. Dye SF, Wojtys EM, Fu FH, Fithian DC, Gillquist J (1998) Factors contributing to function of the knee joint after injury or reconstruction of the anterior cruciate ligament. J Bone Joint Surg [Am] 80A:1380–1393

    Google Scholar 

  3. Edwards A, Bull AM, Amis AA (2007) The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament: part 1: tibial attachment. Knee Surg Sports Traumatol Arthrosc 15:1414–1421

    Article  PubMed  Google Scholar 

  4. Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23:1218–1225

    Article  PubMed  Google Scholar 

  5. Fujimoto E, Sumen Y, Deie M, Yasumoto M, Kobayashi K, Ochi M (2004) Anterior cruciate ligament graft impingement against the posterior cruciate ligament: diagnosis using MRI plus three-dimensional reconstruction software. Magn Reson Imag 22:1125–1129

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  7. Hantes ME, Zachos VC, Liantsis A, Venouziou A, Karantanas AH, Malizos KN (2009) Differences in graft orientation using the transtibial and anteromedial portal technique in anterior cruciate ligament reconstruction: a magnetic resonance imaging study. Knee Surg Sports Traumatol Arthrosc 17:880–886

    Article  PubMed  Google Scholar 

  8. Hara K, Mochizuki T, Sekiya I, Yamaguchi K, Akita K, Muneta T (2009) Anatomy of normal human anterior cruciate ligament attachments evaluated by divided small bundles. Am J Sports Med 37:2386–2391

    Article  PubMed  Google Scholar 

  9. Howell SM, Clark JA (1992) Tibial tunnel placement in anterior cruciate ligament reconstructions and graft impingement. Clin Orthop Relat Res 283:187–195

    PubMed  Google Scholar 

  10. 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–S55

    Article  PubMed  Google Scholar 

  11. Iwahashi T, Shino K, Nakata K, Otsubo H, Suzuki T, Amano H, Nakamura N (2010) Direct anterior cruciate ligament insertion to the femur assessed by histology and 3-dimensional volume-rendered computed tomography. Arthroscopy 26:S13–S20

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  13. Mae T, Shino K, Matsumoto N, Hamada M, Yoneda M, Nakata K (2007) Anatomical two-bundle versus Rosenberg’s isometric bi-socket ACL reconstruction: a biomechanical comparison in laxity match pretension. Knee Surg Sports Traumatol Arthrosc 15:328–334

    Article  PubMed  Google Scholar 

  14. Muneta T, Koga H, Mochizuki T, Ju YJ, Hara K, Nimura A, Yagishita K, Sekiya I (2007) A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. Arthroscopy 23:618–628

    Article  PubMed  Google Scholar 

  15. Purnell ML, Larson AI, Clancy W (2008) Anterior cruciate ligament insertions on the tibia and femur and their relationships to critical bony landmarks using high-resolution volume-rendering computed tomography. Am J Sports Med 36:2083–2090

    Article  PubMed  Google Scholar 

  16. Shino K, Suzuki T, Iwahashi T, Mae T, Nakamura N, Nakata K, Nakagawa S (2010) The resident’s ridge as an arthroscopic landmark for anatomical femoral tunnel drilling in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1164–1168

    Article  PubMed  Google Scholar 

  17. Staeubli HU, Adam O, Becker W, Burgkart R (1999) Anterior cruciate ligament and intercondylar notch in the coronal oblique plane: anatomy complemented by magnetic resonance imaging in cruciate ligament-intact knees. Arthroscopy 15:349–359

    Article  PubMed  CAS  Google Scholar 

  18. Tanzer M, Lenczner E (1990) The relationship of intercondylar notch size and content to notchplasty requirement in anterior cruciate ligament surgery. Arthroscopy 6:89–93

    Article  PubMed  CAS  Google Scholar 

  19. Voos JE, Musahl V, Maak TG, Wickiewicz TL, Pearle AD (2010) Comparison of tunnel positions in single-bundle anterior cruciate ligament reconstructions using computer navigation. Knee Surg Sports Traumatol Arthrosc 18:1282–1289

    Google Scholar 

  20. Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL (2002) Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30:660–666

    PubMed  Google Scholar 

  21. Yamaguchi S, Sasho T, Tsuchiya A, Wada Y, Moriya H (2006) Long term results of anterior cruciate ligament reconstruction with iliotibial tract: 6-, 13-, and 24-year longitudinal follow-up. Knee Surg Sports Traumatol Arthrosc 14:1094–1100

    Article  PubMed  Google Scholar 

  22. Yoon KH, Bae DK, Cho SM, Park SY, Lee JH (2009) Standard anterior cruciate ligament reconstruction versus isolated single-bundle augmentation with hamstring autograft. Arthroscopy 25:1265–1274

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Sports Orthopaedics, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 583-8555, Japan

    Yoshinari Tanaka, Yasukazu Yonetani, Takashi Kanamoto & Shuji Horibe

  2. Department of Orthopaedic Surgery, Seifu Hospital, Sakai, Japan

    Yoshiki Shiozaki

  3. Department of Orthopaedic Surgery, Osaka General Medical Center, Sakai, Japan

    Akira Tsujii

Authors
  1. Yoshinari Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshiki Shiozaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasukazu Yonetani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takashi Kanamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Akira Tsujii
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shuji Horibe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yoshinari Tanaka.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tanaka, Y., Shiozaki, Y., Yonetani, Y. et al. MRI analysis of the attachment of the anteromedial and posterolateral bundles of anterior cruciate ligament using coronal oblique images. Knee Surg Sports Traumatol Arthrosc 19 (Suppl 1), 54–59 (2011). https://doi.org/10.1007/s00167-011-1515-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-011-1515-z

Keywords

Search

Navigation