Skip to main content
SpringerLink
Log in

A systematic review of the femoral origin and tibial insertion morphology of the ACL

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

Abstract

Transtibial single bundle anterior cruciate ligament (ACL) reconstruction has been the gold standard for several years. This technique often fails to restore native ACL femoral origin and tibial insertion anatomy of the ACL. Recently, there is a strong trend towards a more anatomical approach in single and double bundle ACL reconstruction. Using the anatomic double bundle structure of the ACL as a principle, the entirety of both tibial insertion and femoral origin of both bundles, the posterolateral and anteromedial, may be restored. Reflected by recent publications over the past two years, there is an increasing interest in the anatomy of the ACL. In the current study, a PubMed literature search was performed looking for measurements of the ACL femoral origin and tibial insertion. These studies show a large variability in the size and the anatomy of the femoral origin and tibial ACL insertion using different methods and specimens. The diversity of reported measurements makes clinical application of these data difficult at best. Thus, it is of paramount importance to understand the individual variations in size and shape of the ACL femoral origin and tibial ACL insertion. This study is a systematic review of the morphology of the ACL femoral origin and tibial insertion as reported in the literature.

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

Similar content being viewed by others

References

  1. Amis AA, Dawkins GP (1991) Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. J Bone Joint Surg Br 73:260–267

    PubMed  CAS  Google Scholar 

  2. Arnoczky SP (1983) Anatomy of the anterior cruciate ligament. Clin Orthop Relat Res 45:19–25

    Google Scholar 

  3. Biau DJ, Tournoux C, Katsahian S et al (2006) Bone–patellar tendon–bone autografts versus hamstring autografts for reconstruction of anterior cruciate ligament: meta-analysis. BMJ 332:995–1001

    Article  PubMed  Google Scholar 

  4. Biau DJ, Tournoux C, Katsahian S et al (2007) ACL reconstruction: a meta-analysis of functional scores. Clin Orthop Relat Res 458:180–187

    PubMed  Google Scholar 

  5. Chouliaras P, Paessler H (2007) The history of the anterior cruciate ligament from Galen to double-bundle ACL reconstruction. Acta Orthop Traum Hellenica 12:127–131

    Google Scholar 

  6. Colombet P, Robinson J, Christel P et al (2006) Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy 22:984–992

    PubMed  Google Scholar 

  7. Cuomo P, Edwards A, Giron F et al (2006) Validation of the 65 degrees Howell guide for anterior cruciate ligament reconstruction. Arthroscopy 22:70–75

    PubMed  Google Scholar 

  8. Dargel J, Pohl P, Tzikaras P et al (2006) Morphometric side-to-side differences in human cruciate ligament insertions. Surg Radiol Anat 28:398–402

    Article  PubMed  Google Scholar 

  9. Dienst M, Burks RT, Greis PE (2002) Anatomy and biomechanics of the anterior cruciate ligament. Orthop Clin North Am 33:605–620

    Article  PubMed  Google Scholar 

  10. 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 

  11. Edwards A, Bull AM, Amis AA (2008) The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament: Part 2: femoral attachment. Knee Surg Sports Traumatol Arthrosc 16:29–36

    Article  PubMed  Google Scholar 

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

    PubMed  Google Scholar 

  13. Fithian DC, Paxton EW, Stone ML et al (2005) Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee. Am J Sports Med 33:335–346

    Article  PubMed  Google Scholar 

  14. Freedman KB, D’Amato MJ, Nedeff DD et al (2003) Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31:2–11

    PubMed  Google Scholar 

  15. Fu FH, Shen W, Starman JS et al (2008) Primary anatomic double-bundle anterior cruciate ligament reconstruction: a preliminary 2-year prospective Study. Am J Sports Med. Epub ahead of print

  16. Gabriel MT, Wong EK, Woo SL et al (2004) Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads. J Orthop Res 22:85–89

    Article  PubMed  Google Scholar 

  17. 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 

  18. Harner CD, Baek GH, Vogrin TM et al (1999) Quantitative analysis of human cruciate ligament insertions. Arthroscopy 15:741–749

    PubMed  CAS  Google Scholar 

  19. Harner CD, Livesay GA, Kashiwaguchi S et al (1995) Comparative study of the size and shape of human anterior and posterior cruciate ligaments. J Orthop Res 13:429–434

    Article  PubMed  CAS  Google Scholar 

  20. Heming JF, Rand J, Steiner ME (2007) Anatomical limitations of transtibial drilling in anterior cruciate ligament reconstruction. Am J Sports Med 35:1708–1715

    Article  PubMed  Google Scholar 

  21. Järvelä T, Moisala AS, Sihvonen R et al (2008) Double-bundle anterior cruciate ligament reconstruction using hamstring autografts and bioabsorbable interference screw fixation: prospective, randomized, clinical study with 2-year results. Am J Sports Med 36:290–297

    Article  PubMed  Google Scholar 

  22. Kannus P, Järvinen M (1987) Long-term prognosis of non-operatively treated acute knee distortions having primary hemarthrosis without clinical instability. Am J Sports Med 15:138–143

    Article  PubMed  CAS  Google Scholar 

  23. Kennedy JC, Weinberg HW, Wilson AS (1974) The anatomy and function of the anterior cruciate ligament. As determined by clinical and morphological studies. J Bone Joint Surg Am 56:223–235

    PubMed  CAS  Google Scholar 

  24. Lee GC, Cushner FD, Vigoritta V et al (2005) Evaluation of the anterior cruciate ligament integrity and degenerative arthritic patterns in patients undergoing total knee arthroplasty. J Arthroplasty 20:59–65

    Article  PubMed  Google Scholar 

  25. Lohmander LS, Östenberg A, Englund M et al (2004) High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 50:3145–3152

    Article  PubMed  CAS  Google Scholar 

  26. Luites JW, Wymenga AB, Blankevoort L et al (2007) Description of the attachment geometry of the anteromedial and posterolateral bundles of the ACL from arthroscopic perspective for anatomical tunnel placement. Knee Surg Sports Traumatol Arthrosc 15:1422–1431

    Article  PubMed  Google Scholar 

  27. McDaniel WJ, Dameron TB (1983) The untreated anterior cruciate ligament rupture. Clin Orthop Relat Res 172:158–163

    PubMed  Google Scholar 

  28. Mochizuki T, Muneta T, Nagase T et al (2006) Cadaveric knee observation study for describing anatomic femoral tunnel placement for two-bundle anterior cruciate ligament reconstruction. Arthroscopy 22:356–361

    PubMed  Google Scholar 

  29. Morgan CD, Kalman VR, Grawl DM (1995) Definitive landmarks for reproducible tibial tunnel placement in anterior cruciate ligament reconstruction. Arthroscopy 11:275–288

    PubMed  CAS  Google Scholar 

  30. Mullaji AB, Marawar SV, Simha M et al (2008) Cruciate ligaments in arthritic knees; a histologic study with radiologic correlation. J Arthroplasty 23:567–572

    Article  PubMed  Google Scholar 

  31. Muneta T, Takakuda K, Yamamoto H (1997) Intercondylar notch width and its relation to the configuration and cross-sectional area of the anterior cruciate ligament. A cadaveric knee study. Am J Sports Med 25:69–72

    Article  PubMed  CAS  Google Scholar 

  32. Neyret P, Donell ST, Dejour H (1993) Results of partial meniscectomy related to the state of the anterior cruciate ligament. Review at 20 to 35 years. J Bone Joint Surg Br 75:36–40

    PubMed  CAS  Google Scholar 

  33. Noyes FR, Mooar PA, Matthews DS et al (1983) The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. J Bone Joint Surg Am 65:154–162

    PubMed  CAS  Google Scholar 

  34. Odensten M, Gillquist J (1985) Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg Am 67:257–262

    PubMed  CAS  Google Scholar 

  35. Petersen W, Tretow H, Weimann A et al (2007) Biomechanical evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction: one tibial tunnel versus two tibial tunnels. Am J Sports Med 35:228–234

    Article  PubMed  Google Scholar 

  36. Sakane M, Fox RJ, Woo SL et al (1997) In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res 15:285–293

    Article  PubMed  CAS  Google Scholar 

  37. Siebold R, Dehler C, Ellert T (2008) Prospective randomized comparison of double-bundle versus single-bundle anterior cruciate ligament reconstruction. Arthroscopy 24:137–145

    Article  PubMed  Google Scholar 

  38. Siebold R, Ellert T, Metz S et al (2008) Femoral insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry and arthroscopic orientation models for double-bundle bone tunnel placement—a cadaver study. Arthroscopy 24:585–592

    Article  PubMed  Google Scholar 

  39. Siebold R, Ellert T, Metz S et al (2008) Tibial insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry, arthroscopic landmarks, and orientation model for bone tunnel placement. Arthroscopy 24:154–161

    Article  PubMed  Google Scholar 

  40. Sommerlath K, Lysholm J, Gillquist J (1991) The long-term course after treatment of acute anterior cruciate ligament ruptures. A 9-to–16 year follow-up. Am J Sports Med 19:156–162

    Article  PubMed  CAS  Google Scholar 

  41. Stäubli HU, Rauschning W (1994) Tibial attachment area of the anterior cruciate ligament in the extended knee position. Anatomy and cryosections in vitro complemented by magnetic resonance arthrography in vivo. Knee Surg Sports Traumatol Arthrosc 2:138–146

    Article  PubMed  Google Scholar 

  42. Takahashi M, Doi M, Abe M et al (2006) Anatomical study of the femoral and tibial insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament. Am J Sports Med 34:787–792

    Article  PubMed  Google Scholar 

  43. Tashman S, Collon D, Anderson K et al (2004) Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med 32:975–983

    Article  PubMed  Google Scholar 

  44. Tállay A, Lim MH, Bartlett J (2008) Anatomical study of the human anterior cruciate ligament stump’s tibial insertion footprint. Knee Surg Sports Traumatol Arthrosc 16:741–746

    Article  PubMed  Google Scholar 

  45. Tsukada H, Ishibashi Y, Tsuda E et al (2008) Anatomical analysis of the anterior cruciate ligament femoral and tibial footprints. J Orthop Sci 13:122–129

    Article  PubMed  Google Scholar 

  46. Weber WE, Weber EFW (1836) Mechanik der menschlichen Gehwerkzeuge: eine anatomisch-physiologische Untersuchung. Dietrische Buchhandlung, Göttingen

    Google Scholar 

  47. Yagi M, Wong EK, Kanamori A et al (2002) Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30:660–666

    PubMed  Google Scholar 

  48. Yasuda K, Kondo E, Ichiyama H et al (2006) Clinical evaluation of anatomic double-bundle anterior cruciate ligament reconstruction procedure using hamstring tendon grafts: comparisons among 3 different procedures. Arthroscopy 22:240–251

    Article  PubMed  Google Scholar 

  49. Zantop T, Herbort M, Raschke MJ et al (2007) The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation. Am J Sports Med 35:223–227

    Article  PubMed  Google Scholar 

  50. Zantop T, Petersen W, Sekiya JK et al (2006) Anterior cruciate ligament anatomy and function relating to anatomical reconstruction. Knee Surg Sports Traumatol Arthrosc 14:982–992

    Article  PubMed  Google Scholar 

  51. Zantop T, Wellmann M, Fu FH et al (2008) Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med 36:65–72

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

No potential conflict of interest declared.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA

    Sebastian Kopf, Volker Musahl, Scott Tashman, Michal Szczodry, Wei Shen & Freddie H. Fu

Authors
  1. Sebastian Kopf
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Volker Musahl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Scott Tashman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michal Szczodry
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wei Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Freddie H. Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Scott Tashman.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kopf, S., Musahl, V., Tashman, S. et al. A systematic review of the femoral origin and tibial insertion morphology of the ACL. Knee Surg Sports Traumatol Arthrosc 17, 213–219 (2009). https://doi.org/10.1007/s00167-008-0709-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-008-0709-5

Keywords

Search

Navigation