Skip to main content
SpringerLink
Log in

The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament

Part 1: Tibial attachment

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

Abstract

The tibial attachments of the individual anteromedial (AM) and posterolateral (PL) fibre bundles and the entire attachment of the anterior cruciate ligament are described, relating them to consistent bony landmarks; 55 fresh-frozen specimens were measured. The fibre bundles were separated and excised at their attachments and their peripheries marked with a pen. High-resolution scaled digital photographs were taken of each dissected specimen and transferred onto a computer for analysis. A wide variation was found when using the posterior tibial axis, the anterior tibial surface and the medial tibial spine as reference points. The most consistent measurements used the tibial interspinous “over-the-back” ridge as a datum. The attachments of the PL and AM bundles were centred 10 ± 1 mm (mean ± SD) and 17 ± 2 mm anterior to the over-the-back ridge. They were 4 ± 1 and 5 ± 1 mm, respectively, lateral to the medial tibial spine border. The positions of 6 mm circles in the posterior-medial limits of the fibre bundles (representing tunnels in a double-tunnel reconstruction) were measured. The overall dimensions of the tibial plateaux correlated significantly with many measurements. The results from this study could be used to guide ACL reconstruction techniques.

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
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Amis AA, Beynnon B, Blankevoort L, Chambat P, Christel P, Durselen L, Friederich N, Grood E, Hertel P, Jakob R (1994) Proceedings of the ESSKA scientific workshop on reconstruction of the anterior and posterior cruciate ligaments. Knee Surg Sports Traumatol Arthrosc 2:124–132

    Article  PubMed  CAS  Google Scholar 

  2. 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 

  3. Amis AA, Jakob RP (1998) Anterior cruciate ligament graft positioning, tensioning and twisting. Knee Surg Sports Traumatol Arthrosc 6(Suppl 1):S2–S12

    Article  PubMed  Google Scholar 

  4. Berg EE (1993) Parsons’ knob (tuberculum intercondylare tertium). A guide to tibial anterior cruciate ligament insertion. Clin Orthop Relat Res 292: 229–231

    PubMed  Google Scholar 

  5. Chhabra A, Starman JS, Ferretti M, Vidal AF, Zantop T, Fu FH (2006) Anatomic, radiographic, biomechanical, and kinematic evaluation of the anterior cruciate ligament and its two functional bundles. J Bone Joint Surg Am 88(Suppl 4):2–10

    Article  PubMed  Google Scholar 

  6. Colombet P, Robinson J, Christel P, Franceschi JP, Djian P, Bellier G, Sbihi A (2006) Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy 22:984–992

    Article  PubMed  Google Scholar 

  7. Ferretti M, Levicoff EA, Macpherson TA, Moreland MS, Cohen M, Fu FH (2007) The fetal anterior cruciate ligament: an anatomic and histologic study. Arthroscopy 23:278–283

    Article  PubMed  Google Scholar 

  8. Friederich NF, O’Brien WR (1992) Functional anatomy of the cruciate ligaments. In: Jakob RP, Staubli HU (eds) The knee and the cruciate ligaments. Springer, Berlin

    Google Scholar 

  9. Harner CD, Baek GH, Vogrin TM, Carlin GJ, Kashiwaguchi S, Woo SL (1999) Quantitative analysis of human cruciate ligament insertions. Arthroscopy 15:741–749

    Article  PubMed  CAS  Google Scholar 

  10. Howell SM (1998) Principles for placing the tibial tunnel and avoiding roof impingement during reconstruction of a torn anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 6:S49–S55

    Article  PubMed  Google Scholar 

  11. Hutchinson MR, Bae TS (2001) Reproducibility of anatomic tibial landmarks for anterior cruciate ligament reconstructions. Am J Sports Med 29:777–780

    PubMed  CAS  Google Scholar 

  12. Ikeda H, Muneta T, Niga S, Hoshino A, Asahina S, Yamamoto H (1999) The long-term effects of tibial drill hole position on the outcome of anterior cruciate ligament reconstruction. Arthroscopy 15:287–291

    Article  PubMed  CAS  Google Scholar 

  13. Jackson DW, Schaefer RK (1990) Cyclops syndrome: loss of extension following intra-articular anterior cruciate ligament reconstruction. Arthroscopy 6:171–178

    Article  PubMed  CAS  Google Scholar 

  14. Kurosawa H, Walker PS, Abe S, Garg A, Hunter T (1985) Geometry and motion of the knee for implant and orthotic design. J Biomech 18:487–499

    Article  PubMed  CAS  Google Scholar 

  15. Morgan CD, Kalman VR, Grawl DM (1997) The anatomic origin of the posterior cruciate ligament: where is it? Reference landmarks for PCL reconstruction. Arthroscopy 13:325–331

    Article  PubMed  CAS  Google Scholar 

  16. Muneta T, Yamamoto H, Sakai H, Ishibashi T, Furuya K (1993) Relationship between changes in length and force in in vitro reconstructed anterior cruciate ligament. Am J Sports Med 21:299–304

    Article  PubMed  CAS  Google Scholar 

  17. 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 

  18. Sakane M, Fox RJ, Woo SL, Livesay GA, Li G, Fu FH (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 

  19. Sapega AA, Moyer RA, Schneck C, Komalahiranya N (1990) Testing for isometry during reconstruction of the anterior cruciate ligament. Anatomical and biomechanical considerations. J Bone Joint Surg Am 72:259–267

    PubMed  CAS  Google Scholar 

  20. Staubli 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  CAS  Google Scholar 

  21. Takahashi M, Doi M, Abe M, Suzuki D, Nagano A (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 

  22. Takeuchi R, Saito T, Mituhashi S, Suzuki E, Yamada I, Koshino T (2002) Double-bundle anatomic anterior cruciate ligament reconstruction using bone-hamstring-bone composite graft. Arthroscopy 18:550–555

    Article  PubMed  Google Scholar 

  23. Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL (2002) Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30:660–666

    PubMed  Google Scholar 

Download references

Acknowledgments

This research was kindly funded by the London Department of Postgraduate Medical and Dental Education. We acknowledge Ealing Hospital NHS trust for the knee specimens. Dr. Bull was supported by the Arthritis Research Campaign, a charity based in Chesterfield, UK. The authors are not aware of any potential conflict of interest relating to this article.

Author information

Authors and Affiliations

  1. Department of Mechanical Engineering, Imperial College London, London, SW7 2AZ, UK

    Andrew Edwards

  2. Bioengineering Department, Imperial College London, London, SW7 2AZ, UK

    Anthony M. J. Bull

  3. Departments of Mechanical Engineering and Musculoskeletal Surgery, Imperial College London, London, SW7 2AZ, UK

    Andrew A. Amis

Authors
  1. Andrew Edwards
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anthony M. J. Bull
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrew A. Amis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrew A. Amis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Edwards, A., Bull, A.M.J. & Amis, A.A. The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthr 15, 1414–1421 (2007). https://doi.org/10.1007/s00167-007-0417-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-007-0417-6

Keywords

Search

Navigation