Flat midsubstance of the anterior cruciate ligament with tibial "C”-shaped insertion site

Verfasser / Beitragende:
[Rainer Siebold, Peter Schuhmacher, Francis Fernandez, Robert Śmigielski, Christian Fink, Axel Brehmer, Joachim Kirsch]
Ort, Verlag, Jahr:
2015
Enthalten in:
Knee Surgery, Sports Traumatology, Arthroscopy, 23/11(2015-11-01), 3136-3142
Format:
Artikel (online)
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024 7 0 |a 10.1007/s00167-014-3058-6  |2 doi 
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245 0 0 |a Flat midsubstance of the anterior cruciate ligament with tibial "C”-shaped insertion site  |h [Elektronische Daten]  |c [Rainer Siebold, Peter Schuhmacher, Francis Fernandez, Robert Śmigielski, Christian Fink, Axel Brehmer, Joachim Kirsch] 
520 3 |a Purpose: This anatomical cadaver study was performed to investigate the flat appearance of the midsubstance shape of the anterior cruciate ligament (ACL) and its tibial "C”-shaped insertion site. Methods: The ACL midsubstance and the tibial ACL insertion were dissected in 20 cadaveric knees (n=6 fresh frozen and n=14 paraffined). Magnifying spectacles were used for all dissections. Morphometric measurements were performed using callipers and on digital photographs. Results: In all specimens, the midsubstance of the ACL was flat with a mean width of 9.9mm, thickness of 3.9mm and cross-sectional area of 38.7mm2. The "direct” "C”-shaped tibial insertion runs from along the medial tibial spine to the anterior aspect of the lateral meniscus. The mean width (length) of the "C” was 12.6mm, its thickness 3.3mm and area 31.4mm2. The centre of the "C” was the bony insertion of the anterior root of the lateral meniscus overlayed by fat and crossed by the ACL. No posterolateral (PL) inserting ACL fibres were found. Together with the larger "indirect” part (area 79.6mm2), the "direct” one formed a "duck-foot”-shaped footprint. Conclusion: The tibial ACL midsubstance and tibial "C”-shaped insertion are flat and are resembling a "ribbon”. The centre of the "C” is the bony insertion of the anterior root of the lateral meniscus. There are no central or PL inserting ACL fibres. Anatomical ACL reconstruction may therefore require a flat graft and a "C”-shaped tibial footprint reconstruction with an anteromedial bone tunnel for single bundle and an additional posteromedial bone tunnel for double bundle. 
540 |a The Author(s), 2014 
690 7 |a ACL  |2 nationallicence 
690 7 |a Flat  |2 nationallicence 
690 7 |a Ribbon  |2 nationallicence 
690 7 |a Tibial insertion  |2 nationallicence 
690 7 |a "C”-shaped  |2 nationallicence 
690 7 |a Midsubstance  |2 nationallicence 
700 1 |a Siebold  |D Rainer  |u HKF: Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany  |4 aut 
700 1 |a Schuhmacher  |D Peter  |u HKF: Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany  |4 aut 
700 1 |a Fernandez  |D Francis  |u HKF: Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany  |4 aut 
700 1 |a Śmigielski  |D Robert  |u Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757, Warsaw, Poland  |4 aut 
700 1 |a Fink  |D Christian  |u Sportsclinic Austria, Tivoli Ost, Olympiastr. 39, 6020, Innsbruck, Austria  |4 aut 
700 1 |a Brehmer  |D Axel  |u Institute for Anatomy Lehrstuhl I, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstr. 9, 91054, Erlangen, Germany  |4 aut 
700 1 |a Kirsch  |D Joachim  |u Institute for Anatomy and Cell Biology, INF, Ruprecht-Karls University, Heidelberg, Germany  |4 aut 
773 0 |t Knee Surgery, Sports Traumatology, Arthroscopy  |d Springer Berlin Heidelberg  |g 23/11(2015-11-01), 3136-3142  |x 0942-2056  |q 23:11<3136  |1 2015  |2 23  |o 167 
856 4 0 |u https://doi.org/10.1007/s00167-014-3058-6  |q text/html  |z Onlinezugriff via DOI 
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900 7 |a Metadata rights reserved  |b Springer special CC-BY-NC licence  |2 nationallicence 
908 |D 1  |a research-article  |2 jats 
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950 |B NATIONALLICENCE  |P 856  |E 40  |u https://doi.org/10.1007/s00167-014-3058-6  |q text/html  |z Onlinezugriff via DOI 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Siebold  |D Rainer  |u HKF: Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Schuhmacher  |D Peter  |u HKF: Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Fernandez  |D Francis  |u HKF: Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Śmigielski  |D Robert  |u Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757, Warsaw, Poland  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Fink  |D Christian  |u Sportsclinic Austria, Tivoli Ost, Olympiastr. 39, 6020, Innsbruck, Austria  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Brehmer  |D Axel  |u Institute for Anatomy Lehrstuhl I, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstr. 9, 91054, Erlangen, Germany  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Kirsch  |D Joachim  |u Institute for Anatomy and Cell Biology, INF, Ruprecht-Karls University, Heidelberg, Germany  |4 aut 
950 |B NATIONALLICENCE  |P 773  |E 0-  |t Knee Surgery, Sports Traumatology, Arthroscopy  |d Springer Berlin Heidelberg  |g 23/11(2015-11-01), 3136-3142  |x 0942-2056  |q 23:11<3136  |1 2015  |2 23  |o 167