Femoral attachment of the anterior cruciate ligament

Endoscopic anterior cruciate ligament (ACL) reconstruction is one of the most popular orthopaedic procedures. Correct tunnel positioning is a prerequisite to success. Current surgical techniques are unable to duplicate the complex anatomy and function of the native ACL. Surgery mainly aims at restoring anteroposterior laxity. The ACL is not isometric and only a few fibers are nearly isometric over the full range of motion. However, a nearly isometric behaviour of the ACL graft is desirable. Isometry is mainly influenced by femoral attachment; thus the femoral tunnel position has a greater effect than the tibial on graft length changes. The purpose of this article is to describe the anatomy of the femoral ACL insertion and to discuss the surgical techniques used to replicate it.

[1]  Freddie H. Fu,et al.  The Effectiveness of Reconstruction of the Anterior Cruciate Ligament with Hamstrings and Patellar Tendon: A Cadaveric Study Comparing Anterior Tibial and Rotational Loads , 2002, The Journal of bone and joint surgery. American volume.

[2]  B. Bach,et al.  Single-Incision Endoscopic Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Autograft , 1998, The American journal of sports medicine.

[3]  K. Shino,et al.  Single- versus bi-socket anterior cruciate ligament reconstruction using autogenous multiple-stranded hamstring tendons with endoButton femoral fixation: A prospective study. , 2001, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[4]  L. Blankevoort,et al.  Proceedings of the ESSKA Scientific Workshop on Reconstruction of the Anterior and Posterior Cruciate Ligaments , 2005, Knee Surgery, Sports Traumatology, Arthroscopy.

[5]  E S Grood,et al.  Factors affecting the region of most isometric femoral attachments , 1989, The American journal of sports medicine.

[6]  A A Amis,et al.  Intraoperative measurement of knee kinematics in reconstruction of the anterior cruciate ligament. , 2002, The Journal of bone and joint surgery. British volume.

[7]  T. Muneta,et al.  Relationship between changes in length and force in in vitro reconstructed anterior cruciate ligament , 1993, The American journal of sports medicine.

[8]  M. Cross,et al.  Anterior cruciate ligament: functional anatomy of its bundles in rotatory instabilities , 1979, The American journal of sports medicine.

[9]  S M Howell,et al.  The Relationship between the Angle of the Tibial Tunnel in the Coronal Plane and Loss of Flexion and Anterior Laxity after Anterior Cruciate Ligament Reconstruction , 2001, The American journal of sports medicine.

[10]  R. Hunter,et al.  The anterior cruciate ligament. , 2017 .

[11]  F. Girgis,et al.  The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. , 1975, Clinical orthopaedics and related research.

[12]  R. Buzzi,et al.  Long-term study of anterior cruciate ligament reconstruction for chronic instability using the central one-third patellar tendon and a lateral extraarticular tenodesis , 1992, The American journal of sports medicine.

[13]  Freddie H. Fu,et al.  2002 Richard O'Connor Award Paper Knee Stability and Graft Function Following Anterior Cruciate Ligament Reconstruction: Comparison Between 11 O'clock and 10 O'clock Femoral Tunnel Placement , 2003 .

[14]  B. Bach,et al.  Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Autograft , 1998, The American journal of sports medicine.

[15]  K G JONES,et al.  RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT. A TECHNIQUE USING THE CENTRAL ONE-THIRD OF THE PATELLAR LIGAMENT. , 1963, The Journal of bone and joint surgery. American volume.

[16]  R. Buzzi,et al.  Femoral tunnel position in anterior cruciate ligament reconstruction using three techniques. A cadaver study. , 1999, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[17]  D FitzPatrick,et al.  Orientation of the cruciate ligament in the sagittal plane. A method of predicting its length-change with flexion. , 1988, The Journal of bone and joint surgery. British volume.

[18]  S. Petrie,et al.  In vitro comparison of elongation of the anterior cruciate ligament and single- and dual-tunnel anterior cruciate ligament reconstructions. , 1999, Orthopedics.

[19]  L. Pinczewski,et al.  Arthroscopic reconstruction of the anterior cruciate ligament with patellar-tendon autograft and interference screw fixation. The results at seven years. , 1999, The Journal of bone and joint surgery. British volume.

[20]  L. Engebretsen,et al.  Accuracy of femoral tunnel placement and resulting graft force using one- or two-incision drill guides. A cadaver study on ten paired knees. , 1996, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[21]  A. Amis,et al.  Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. , 1991, The Journal of bone and joint surgery. British volume.

[22]  N. Stergiou,et al.  The effects of anterior cruciate ligament reconstruction on tibial rotation during pivoting after descending stairs , 2003, Knee Surgery, Sports Traumatology, Arthroscopy.

[23]  Freddie H. Fu,et al.  In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads , 1997, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[24]  Ao Yingfan,et al.  Arthroscopic-assisted anterior cruciate ligament reconstruction , 2001 .

[25]  Markus P. Arnold,et al.  Single-incision technique misses the anatomical femoral anterior cruciate ligament insertion: a cadaver study , 2001, Knee Surgery, Sports Traumatology, Arthroscopy.

[26]  I. Sekiya,et al.  Two-bundle reconstruction of the anterior cruciate ligament using semitendinosus tendon with endobuttons: operative technique and preliminary results. , 1999, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[27]  Walter R. O'Brien,et al.  Isometric placement of anterior cruciate ligament substitutes , 1992 .

[28]  K. Markolf,et al.  Biomechanical Consequences of Replacement of the Anterior Cruciate Ligament with a Patellar Ligament Allograft. Part I: Insertion of the Graft and Anterior-Posterior Testing* , 1996, The Journal of bone and joint surgery. American volume.

[29]  S M Howell,et al.  Failure of reconstruction of the anterior cruciate ligament due to impingement by the intercondylar roof. , 1993, The Journal of bone and joint surgery. American volume.

[30]  Kevin M. Guskiewicz,et al.  Cryotherapy in Sport Injury Management , 1996 .

[31]  H. Yoshikawa,et al.  Single- versus two-femoral socket anterior cruciate ligament reconstruction technique: Biomechanical analysis using a robotic simulator. , 2001, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[32]  Freddie H. Fu,et al.  Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o'clock and 10 o'clock femoral tunnel placement. 2002 Richard O'Connor Award paper. , 2003, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[33]  J. Moseley,et al.  Increased Tibial Translation After Partial Sectioning of the Anterior Cruciate Ligament , 1996, The American journal of sports medicine.

[34]  S. Arnoczky,et al.  The Anterior cruciate ligament : current and future concepts , 1993 .

[35]  Y. Koga,et al.  Influence of the Femoral Tunnel Location and Angle on the Contact Pressure in the Femoral Tunnel in Anterior Cruciate Ligament Reconstruction , 2003, The American journal of sports medicine.

[36]  K. Shelbourne,et al.  Anterior Cruciate Ligament Reconstruction with Autogenous Patellar Tendon Graft Followed by Accelerated Rehabilitation , 1997, The American journal of sports medicine.

[37]  L. Snyder-Mackler,et al.  Fate of the ACL-injured patient: a prospective outcome study. , 1995, The American journal of sports medicine.

[38]  M. L. Hull,et al.  Effect of the Angle of the Femoral and Tibial Tunnels in the Coronal Plane and Incremental Excision of the Posterior Cruciate Ligament on Tension of an Anterior Cruciate Ligament Graft: An in Vitro Study , 2003, The Journal of bone and joint surgery. American volume.

[39]  F. Girgis,et al.  The anterior cruciate ligament. A functional analysis based on postmortem studies. , 1976, The Journal of bone and joint surgery. American volume.

[40]  Freddie H. Fu,et al.  Biomechanical Analysis of an Anatomic Anterior Cruciate Ligament Reconstruction , 2002, The American journal of sports medicine.

[41]  A A Amis,et al.  Biomechanics of a double prosthetic ligament in the anterior cruciate deficient knee. , 1990, The Journal of bone and joint surgery. British volume.

[42]  C. Schneck,et al.  Testing for isometry during reconstruction of the anterior cruciate ligament. Anatomical and biomechanical considerations. , 1990, The Journal of bone and joint surgery. American volume.

[43]  K Yamakoshi,et al.  Simultaneous measurement of changes in length of the cruciate ligaments during knee motion. , 1991, Clinical orthopaedics and related research.

[44]  S. Woo,et al.  Quantitative analysis of human cruciate ligament insertions. , 1999, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[45]  Scott Tashman,et al.  Abnormal Rotational Knee Motion during Running after Anterior Cruciate Ligament Reconstruction , 2004, The American journal of sports medicine.

[46]  A. A. Amis,et al.  A comparative study of ’isometric’ points for anterior cruciate ligament graft attachment , 2001, Knee Surgery, Sports Traumatology, Arthroscopy.