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. 2015 Nov;23(11):3143-50.
doi: 10.1007/s00167-014-3146-7. Epub 2014 Jun 28.

Ribbon like appearance of the midsubstance fibres of the anterior cruciate ligament close to its femoral insertion site: a cadaveric study including 111 knees

Robert Śmigielski  1 , Urszula Zdanowicz  2 , Michał Drwięga  2 , Bogdan Ciszek  3 , Beata Ciszkowska-Łysoń  4 , Rainer Siebold  5   6
Affiliations

Ribbon like appearance of the midsubstance fibres of the anterior cruciate ligament close to its femoral insertion site: a cadaveric study including 111 knees

Robert Śmigielski et al. Knee Surg Sports Traumatol Arthrosc. 2015 Nov.

Abstract

Purpose: Recently, the configuration of the anterior cruciate ligament (ACL) from its direct femoral insertion to midsubstance was found to be flat. This might have an important impact for anatomical ACL reconstruction. The purpose of this anatomical study was to evaluate the macroscopic appearance of the ACL from femoral to midsubstance.

Methods: The ACL was dissected in 111 human fresh frozen cadaver knees from its femoral insertion to midsubstance, and the shape was described. The anatomical findings were documented on digital photographs and on video. Thirty knees were sent for computed tomography (CT), magnetic resonance imaging (MRI) and histology of the femoral ACL insertion.

Results: Two millimetres from its direct femoral insertion, the ACL fibres formed a flat ribbon in all dissected knees without a clear separation between AM and PL bundles. The ribbon was in exact continuity of the posterior femoral cortex. The width of the ribbon was between 11.43 and 16.18 mm and the thickness of the ACL was only 2.54-3.38 mm. 3D CT, MRI and the histological examination confirmed above findings.

Conclusion: This is a detailed anatomical study describing the ribbon-like structure of the ACL from its femoral insertion to midsubstance. A key point was to carefully remove the surface fibrous membrane of the ACL. A total of 2-3 mm from its bony femoral insertion, the ACL formed a flat ribbon without a clear separation between AM and PL bundles. The ribbon was in exact continuity of the posterior femoral cortex. The findings of a flat ligament may change the future approach to femoral ACL footprint and midsubstance ACL reconstruction and to graft selection.

Keywords: ACL; Anatomy; Anterior cruciate ligament; Femoral insertion; Intraligamentous; Midsubstance; Ribbon.

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Figures

Fig. 1
Fig. 1
a–c The ribbon shape of the ACL after careful removal of the synovial tissue: The ACL fibres form a flat ribbon 2 mm from its femoral attachment to midsubstance
Fig. 2
Fig. 2
a, b The direct insertion of the ribbon-like ACL fibres is in continuity of the posterior femoral cortex
Fig. 3
Fig. 3
a–c Measurement of the midsubstance width, thickness and long axis of the ACL using a calliper
Fig. 4
Fig. 4
a–b Histology of the direct femoral insertion of the ACL: macroscopic view (a) and microscopic view (b, c), (light microscopy, H&E stain, original magnification ×4). b Note the sharp angle at which the fibres attach to the bone. Notice c double tidemark—marked with arrows
See this image and copyright information in PMC

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