Anat Cell Biol.  2020 Dec;53(4):398-404. 10.5115/acb.20.119.

New insights in anterior cruciate ligament morphology: implications for anterior cruciate ligament reconstruction surgeries

• Lalwani R
• Srivastava R
• Kotgirwar S
• Athavale SA

• KMID: 2509684
• DOI: http://doi.org/10.5115/acb.20.119

Abstract

The frequency of injury of anterior cruciate ligament (ACL), the importance of anatomy in surgical repair and potential of the injured ACL to predispose to osteoarthritis necessitates the need for understanding its precise anatomy. Available studies have focussed on tunnel positioning and hence attachment site of the ligament. Few studies which have focussed on morphology reflect ambiguities in size, fibre bundle, number and disposition. Since a near anatomical repair of the ACL is the treatment of choice, the present study was planned to describe the morphology of ACL. Twenty-two ACL (11 right and 11 left) isolated from knee joints of collection of adult embalmed lower limbs were utilised for the study. The ACL morphology and morphometry were studied for footprints and fibre bundles. Three distinct bundles of differing lengths constitute a spiral ACL complex. These bundles are positioned as- intermediate with posteromedial and anterolateral flanking in respective positions. The tibial and femoral footprints are paw-shaped and oval respectively. Tibial footprints are approximately 2.5 times larger in area than the femoral footprints. The unique morphology of ACL vis a vis its spiralization, and its mechanical advantage of in terminal extension and conjunct rotation of knee (which are peculiarly human trait) are discussed. It is recommended to utilize the concept of spiralization and differing bundle length in ACL surgeries to achieve the favourable clinical outcome.

Keyword

Anterior cruciate ligament; Mechanics; Knee joint; Knee joint

Figure

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  Fig. 1 Shows the footprints of ACL. (A) Shows the morphology of paw-shaped tibial footprints. (B) Shows oval, elongated and mediolaterally flattened femoral footprints. ACL, anterior cruciate ligament.

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  Fig. 2 (A–C) Shows the three bundles of ACL and their relative positioning. Shows the presence of three distinct fibre bundles and the relative positioning of the different fibre bundles as seen in the (A) right and (B) left ACL. C shows ACL from posterior aspect; three bundles can be seen with fibres of posteromedial bundle spiralling posterior to the intermediate bundle. ACL, anterior cruciate ligament; AL, anterolateral bundle; I, intermediate bundle; PM, posteromedial bundle.

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  Fig. 3 Shows the medially spiralized fibre arrangement of the intermediate bundle of the right side. Inf, inferior; Lat, lateral; Med, medial; Sup, superior.

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  Fig. 4 Shows the schematic diagram of ACL as visualized from the superior aspect to see the femoral footprints. The different arrangements of fibre bundles based on their relative position in ACL femoral footprints are seen. A, anterior; ACL, anterior cruciate ligament; AL, anterolateral bundle; I, intermediate bundle; L, lateral; M, medial; P, posterior; PM, posteromedial bundle.

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  Fig. 5 Showing fanning fibres of AL crossing over from lateral to medial side of the I on the right side. Posteromedial bundle of this ACL was very small and not seen in this view. AL, anterolateral bundle; ACL, anterior cruciate ligament; I, intermediate bundle; Inf, inferior; Med, medial; Lat, lateral; Sup, superior.

Reference

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