caa a22 4500 605460620 CHVBK 20210128100239.0 cr unu---uuuuu 210128e20151101xx s 000 0 eng 10.1007/s00167-014-3058-6 doi (NATIONALLICENCE)springer-10.1007/s00167-014-3058-6 Flat midsubstance of the anterior cruciate ligament with tibial "C”-shaped insertion site [Elektronische Daten] [Rainer Siebold, Peter Schuhmacher, Francis Fernandez, Robert Śmigielski, Christian Fink, Axel Brehmer, Joachim Kirsch] 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. The Author(s), 2014 ACL nationallicence Flat nationallicence Ribbon nationallicence Tibial insertion nationallicence "C”-shaped nationallicence Midsubstance nationallicence Siebold Rainer HKF: Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany aut Schuhmacher Peter HKF: Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany aut Fernandez Francis HKF: Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany aut Śmigielski Robert Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757, Warsaw, Poland aut Fink Christian Sportsclinic Austria, Tivoli Ost, Olympiastr. 39, 6020, Innsbruck, Austria aut Brehmer Axel Institute for Anatomy Lehrstuhl I, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstr. 9, 91054, Erlangen, Germany aut Kirsch Joachim Institute for Anatomy and Cell Biology, INF, Ruprecht-Karls University, Heidelberg, Germany aut Knee Surgery, Sports Traumatology, Arthroscopy Springer Berlin Heidelberg 23/11(2015-11-01), 3136-3142 0942-2056 23:11<3136 2015 23 167 https://doi.org/10.1007/s00167-014-3058-6 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00167-014-3058-6 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Siebold Rainer HKF: Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany aut NATIONALLICENCE 700 1- Schuhmacher Peter HKF: Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany aut NATIONALLICENCE 700 1- Fernandez Francis HKF: Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstrasse 9-15, 69115, Heidelberg, Germany aut NATIONALLICENCE 700 1- Śmigielski Robert Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757, Warsaw, Poland aut NATIONALLICENCE 700 1- Fink Christian Sportsclinic Austria, Tivoli Ost, Olympiastr. 39, 6020, Innsbruck, Austria aut NATIONALLICENCE 700 1- Brehmer Axel Institute for Anatomy Lehrstuhl I, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstr. 9, 91054, Erlangen, Germany aut NATIONALLICENCE 700 1- Kirsch Joachim Institute for Anatomy and Cell Biology, INF, Ruprecht-Karls University, Heidelberg, Germany aut NATIONALLICENCE 773 0- Knee Surgery, Sports Traumatology, Arthroscopy Springer Berlin Heidelberg 23/11(2015-11-01), 3136-3142 0942-2056 23:11<3136 2015 23 167