Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original articlesAnatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts
Section snippets
Anatomic study
An anatomic study was performed with a total of 8 cadaveric knees. In 5 of the 8 knees, the muscles and the tendons around the joint as well as the capsular ligaments were removed. In the primary observation, the shape and function of the ACL were noted in the various positions of the knee. Then the femur was split in the sagittal plane with an oscillating saw, and the posterior cruciate ligament with the medial half of the femur was resected from the tibial insertion. This exposure allowed us
Anatomic observations
On the medial surface of the lateral femoral condyle, a footprint of the ACL attachment was in the form of an egg with its long axis inclined toward the posterior direction by 30° to the long axis of the femur (Fig 5A). When we drew a vertical line (defined as V-line) through the contact point between the femoral condyle and the tibial plateau on a digital image taken at 90° of flexion, the V-line and the long axis of the ACL attachment were crossed at the point on the vertical line 5 to 8 mm
Discussion
This study demonstrated a new procedure to anatomically reconstruct the anteromedial and posterolateral bundles of the ACL. Concerning tunnel positioning on the femur, the first important point was that we found the following anatomic facts: The footprint on the femur is egg-like in shape, and its long axis inclines toward the posterior direction by 30° to the long axis of the femur. Specifically, the center of the attachment (the PL point) of the posterolateral bundle is located approximately
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Supported in part by a Grant-in-Aid for Scientific Research (No. 10558124), from the Ministry of Education, Science and Culture of Japan.