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Review
. 2016 Oct;4(4):291-297.

Anatomical Individualized ACL Reconstruction

Amir Ata Rahnemai-Azar  1 , Soheil Sabzevari  1 , Sebastián Irarrázaval  1 , Tom Chao  1 , Freddie H Fu  1
Affiliations
Review

Anatomical Individualized ACL Reconstruction

Amir Ata Rahnemai-Azar et al. Arch Bone Jt Surg. 2016 Oct.

Abstract

The anterior cruciate ligament (ACL) is composed of two bundles, which work together to provide both antero-posterior and rotatory stability of the knee. Understanding the anatomy and function of the ACL plays a key role in management of patients with ACL injury. Anatomic ACL reconstruction aims to restore the function of the native ACL. Femoral and tibial tunnels should be placed in their anatomical location accounting for both the native ACL insertion site and bony landmarks. One main component of anatomical individualized ACL reconstruction is customizing the treatment according to each patient's individual characteristics, considering preoperative and intraoperative evaluation of the native ACL and knee bony anatomy. Anatomical individualized reconstruction surgery should also aim to restore the size of the native ACL insertion as well. Using this concept, while single bundle ACL reconstruction can restore the function of the ACL in some patients, double bundle reconstruction is indicated in others to achieve optimal outcome.

Keywords: Anatomic ACL reconstruction surgery; Anterior Cruciate Ligament; Individualized medicine.

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Figures

Figure 1
Figure 1
Femoral insertion of the ACL, the “AM” and “PL” denotes the corresponding insertion of posterolateral (PL) and anteromedial (AM) bundle of the ACL. LCF: lateral femoral condyle.
Figure 2
Figure 2
Set up of the right knee in operating position demonstrating the location of the three portals during ACL reconstruction surgery. The exact locations of the portals are finalized during surgery based on individual’s anatomy. AMP: accessory medial portal. AM: anteromedial. AL: anterolateral. TT: tibial tuberosity.
Figure 3
Figure 3
Tibial insertion of the ACL, the “AM” and “PL” denotes the corresponding insertion of posterolateral (PL) and anteromedial (AM) bundle of the ACL. Landmarks of the native ACL play key role in placing the tunnels in anatomic position. LFC: lateral femoral condyle.
Figure 4
Figure 4
Guide pins during double bundle reconstruction surgery. Guide pins are placed in the position of the anteromedial (AM) and posterolateral (PL) bundle of the ACL. The femoral tunnels are drilled. LFC: lateral femoral condyle, PCL: posterior cruciate ligament.
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