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Zhang L, Huang T, Li C, Xing X, Zou D, Dimitriou D, Tsai T, Li P. Race and Gender Differences in Anterior Cruciate Ligament Femoral Footprint Location and Orientation: A 3D-MRI Study. Orthop Surg 2024; 16:216-226. [PMID: 37953405 PMCID: PMC10782238 DOI: 10.1111/os.13918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE The femoral tunnel position is crucial to anatomic single-bundle anterior cruciate ligament (ACL) reconstruction, but the ideal femoral footprint position are mostly based on small-sized cadaveric studies and elderly patients with a single ethnic background. This study aimed to identify potential race- or gender-specific differences in the ACL femoral footprint location and ACL orientation, determine the correlation between the ACL orientation and the femoral footprint location. METHODS Magnetic resonance images (MRIs) of 90 Caucasian participants and 90 matched Chinese subjects were used for reconstruction of three-dimensional (3D) femur and tibial models. ACL footprints were sketched by several experienced orthopedic surgeons on the MRI photographs. The anatomical coordinate system was applied to reflect the ACL footprint location and orientation of scanned samples. The femoral ACL footprint locations were represented by their distance from the origin in the anteroposterior (A/P) and distal-proximal (D/P) directions. The orientation of the ACL was described with the sagittal, coronal and transverse deviation angles. The ACL orientation and femoral footprint position were compared by the two-sided t-test. Multiple regression analysis was used to study the correlation between the orientation and femoral footprint position. RESULTS The average femur footprint A/P position was -6.6 ± 1.6 mm in the Chinese group and -5.1 ± 2.3 mm in the Caucasian group, (p < 0.001). The average femur footprint D/P position was -2.8 ± 2.4 mm in Chinese and - 3.9 ± 2.0 mm in Caucasians, (p = 0.001). The Chinese group had a mean difference of a 1.5 mm (6.1%) more posterior and 1.1 mm (5.3%) more proximal in the position from the flexion-extension axis (FEA). And the males have a sagittal plane elevation about 4-5° higher than females in both racial groups. Furthermore, for every 1% (0.40 mm) increase in A/P and D/P values, the sagittal angle decreased by about 0.12° and 0.24°, respectively; the coronal angle decreased by about 0.10° and 0.30°, respectively. For every 1% (0.40 mm) increase in D/P value, the transverse angle increased by about 0.14°. CONCLUSION The significant race- and gender-specific differences in the femoral footprint and orientation of the ACL should be taken in consideration during anatomic single-bundle ACL reconstruction. Furthermore, the quantitative relationship between the ACL orientation and the footprint location might provide some reference for surgeons to develop a surgical strategy in ACL single-bundle reconstruction and revision.
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Affiliation(s)
- Lihang Zhang
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
| | - Tianwen Huang
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of Joint SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Changzhao Li
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
- Department of Joint SurgeryThe First Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- Department of BiostatisticsBioinformatics & Biomathematics Georgetown UniversityWashington, DCUSA
| | - Xing Xing
- School of Biomedical Engineering & Med‐X Research InstituteShanghai Jiao Tong UniversityShanghaiChina
| | - Diyang Zou
- Engineering Research Center of Digital Medicine and Clinical TranslationMinistry of EducationShanghaiChina
- Department of Orthopedic Surgery, Shanghai Key Laboratory of Orthopedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of OrthopedicsUniversity Hospital BalgristZurichSwitzerland
| | | | - Tsung‐Yuan Tsai
- Engineering Research Center of Digital Medicine and Clinical TranslationMinistry of EducationShanghaiChina
- Department of Orthopedic Surgery, Shanghai Key Laboratory of Orthopedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of OrthopedicsUniversity Hospital BalgristZurichSwitzerland
| | - Pingyue Li
- Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA, The First School of Clinical MedicineSouthern Medical UniversityGuangzhouChina
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Wang W, Tsai TY, Zhang C, Lin J, Dai W, Zhang M, Potthast W, Liu Y, Wang S. Comparison of instantaneous knee kinematics during walking and running. Gait Posture 2022; 97:8-12. [PMID: 35843009 DOI: 10.1016/j.gaitpost.2022.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/13/2022] [Accepted: 07/11/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Accurate measurements of in-vivo knee joint kinematics are essential to elucidate healthy knee motion and the changes that accompany injury and repair. Although numerous experimental measurements have been reported, the accurate non-invasive analysis of in-vivo knee kinematics remains a challenge in biomechanics. RESEARCH QUESTION The study objective was to investigate in-vivo knee kinematics before, at, and after contact during walking and running using a combined high-speed dual fluoroscopic imaging system (DFIS) and magnetic resonance (MR) imaging technique. METHODS Three-dimensional (3D) knee models of ten participants were created using MR images. Knee kinematics during walking and running were determined using high-speed DFIS. The 3D knee models were then related to fluoroscopic images to obtain in-vivo six-degrees-of-freedom knee kinematics. RESULTS Before contact knee flexion, external femoral rotation, and proximal-distal distance were 11.9°, 3.4°, and 1.0 mm greater during running compared to walking, respectively. Similar differences were observed at initial contact (9.9°, 7.9°, and 0.9 mm, respectively) and after contact (6.4°, 2.2°, and 0.8 mm, respectively). Posterior femoral translation at initial contact was also increased during running compared to walking. SIGNIFICANCE This study demonstrated accurate instantaneous in-vivo knee kinematic characteristics that may further the understanding of the intrinsic biomechanics of the knee during gait.
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Affiliation(s)
- Wenjin Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China; Institute of Biomechanics and Orthopedics, German Sport University Cologne, Cologne 50933, Germany
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Cui Zhang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Jinpeng Lin
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Wei Dai
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Ming Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Wolfgang Potthast
- Institute of Biomechanics and Orthopedics, German Sport University Cologne, Cologne 50933, Germany
| | - Yu Liu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai 200438, China.
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Dimitriou D, Cheng R, Yang Y, Helmy N, Tsai TY. Influence of the Anteromedial Portal and Transtibial Drilling Technique on Femoral Tunnel Lengths in ACL Reconstruction: Results Using an MRI-Based Model. Orthop J Sports Med 2022; 10:23259671221096417. [PMID: 35651481 PMCID: PMC9149612 DOI: 10.1177/23259671221096417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background: In anatomic anterior cruciate ligament (ACL) reconstruction, graft placement
through the anteromedial (AM) portal technique requires more horizontal
drilling of the femoral tunnel as compared with the transtibial (TT)
technique, which may lead to a shorter femoral tunnel and affect
graft-to-bone healing. The effect of coronal and sagittal femoral tunnel
obliquity angle on femoral tunnel length has not been investigated. Purpose: To compare the length of the femoral tunnels created with the TT technique
versus the AM portal technique at different coronal and sagittal obliquity
angles using the native femoral ACL center as the starting point of the
femoral tunnel. The authors also assessed sex-based differences in tunnel
lengths. Study Design: Descriptive laboratory study. Methods: Magnetic resonance imaging scans of 95 knees with an ACL rupture (55 men, 40
women; mean age, 26 years [range, 16-45 years]) were used to create
3-dimensional models of the femur. The femoral tunnel was simulated on each
model using the TT and AM portal techniques; for the latter, several coronal
and sagittal obliquity angles were simulated (coronal, 30°, 45°, and 60°;
sagittal, 45° and 60°), representing the 10:00, 10:30, and 11:00 clockface
positions for the right knee. The length of the femoral tunnel was compared
between the techniques and between male and female patients. Results: The mean ± SD femoral tunnel length with the TT technique was 40.0 ± 6.8 mm.
A significantly shorter tunnel was created with the AM portal technique at
30° coronal/45° sagittal (35.5 ± 3.8 mm), whereas a longer tunnel was
created at 60° coronal/60° sagittal (53.3 ± 5.3 mm; P <
.05 for both). The femoral tunnel created with the AM portal technique at
45° coronal/45° sagittal (40.7 ± 4.8 mm) created a similar tunnel length as
the TT technique. For all techniques, the femoral tunnel was significantly
shorter in female patients than male patients. Conclusion: The coronal and sagittal obliquity angles of the femoral tunnel in ACL
reconstruction can significantly affect its length. The femoral tunnel
created with the AM portal technique at 45° coronal/45° sagittal was similar
to that created with the TT technique. Clinical Relevance: Surgeons should be aware of the femoral tunnel shortening with lower coronal
obliquity angles, especially in female patients.
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Affiliation(s)
- Dimitris Dimitriou
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopedics, Bürgerspital Solothurn, Solothurn, Switzerland
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Rongshan Cheng
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yangyang Yang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Naeder Helmy
- Department of Orthopedics, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Dimitriou D, Cheng R, Yang Y, Baumgaertner B, Helmy N, Tsai TY. High variability in anterior cruciate ligament femoral footprint: Implications for anatomical anterior cruciate ligament reconstruction. Knee 2021; 30:141-147. [PMID: 33930701 DOI: 10.1016/j.knee.2021.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The study aimed to (1) investigate the variability of the femoral ACL center in ACL-ruptured patients, (2) identify whether the currently available over-the-top femoral ACL guides could allow for anatomical reconstruction of the native ACL footprint. MATERIAL AND METHODS Magnetic resonance images of 95 knees with an ACL rupture were used to create three-dimensional models of the femur. The femoral ACL footprint area was outlined on each model, and the location of the femoral ACL center was reported using an anatomical coordinate system. The distance of the femoral ACL center from the over-the-top position was measured. RESULTS The femoral ACL center demonstrated a high intersubject variability ranging from 1.8 mm (9%) to 12.3 mm (60%) posterior and from 7.7 mm (37%) distal to 4.8 mm (23%) proximal using the posterior condyle circle reference. The average distance of the femoral ACL center from the over-the-top position was 1.9 ± 1.5 mm posterior and 13.8 ± 2.7 mm distal, respectively. The contemporary over-the-top femoral ACL aimers could restore the femoral ACL center in only 6.5% of the patients. CONCLUSIONS The femoral ACL center demonstrated a high variation on its location, which resulted in a high intersubject variability from the over-the-top position. The contemporary over-the-top femoral tunnel guides do not provide sufficient offset to allow for an anatomical ACL reconstruction. Anteromedial-portal specific femoral ACL guides with a femoral offset ranging from 10 to 18 mm in the proximal/distal direction are required to restore the native ACL footprint.
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Affiliation(s)
- Dimitris Dimitriou
- Department of Orthopedics Bürgerspital Solothurn, Schöngrünstrasse 42, CH-4500 Solothurn, Switzerland
| | - Rongshan Cheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China; Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yangyang Yang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China; Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bodo Baumgaertner
- Department of Orthopedics Bürgerspital Solothurn, Schöngrünstrasse 42, CH-4500 Solothurn, Switzerland
| | - Naeder Helmy
- Department of Orthopedics Bürgerspital Solothurn, Schöngrünstrasse 42, CH-4500 Solothurn, Switzerland
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China; Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Dimitriou D, Zou D, Wang Z, Helmy N, Tsai TY. Anterior cruciate ligament bundle insertions vary between ACL-rupture and non-injured knees. Knee Surg Sports Traumatol Arthrosc 2021; 29:1164-1172. [PMID: 32613337 DOI: 10.1007/s00167-020-06122-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/24/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE The present study aimed to investigate the three-dimensional topographic anatomy of the anterior cruciate ligament (ACL) bundle attachment in both ACL-rupture and ACL-intact patients who suffered a noncontact knee injury and identify potential differences. METHODS Magnetic resonance images of 90 ACL-rupture knees and 90 matched ACL-intact knees, who suffered a noncontact knee injury, were used to create 3D ACL insertion models. RESULTS In the ACL-rupture knees, the femoral origin of the anteromedial (AM) bundle was 24.5 ± 9.0% posterior and 45.5 ± 10.5% proximal to the flexion-extension axis (FEA), whereas the posterolateral (PL) bundle origin was 35.5 ± 12.5% posterior and 22.4 ± 10.3% distal to the FEA. In ACL-rupture knees, the tibial insertion of the AM-bundle was 34.3 ± 4.6% of the tibial plateau depth and 50.7 ± 3.5% of the tibial plateau width, whereas the PL-bundle insertion was 47.5 ± 4.1% of the tibial plateau depth and 56.9 ± 3.4% of the tibial plateau width. In ACL-intact knees, the origin of the AM-bundle was 17.5 ± 9.1% posterior (p < 0.01) and 42.3 ± 10.5% proximal (n.s.) to the FEA, whereas the PL-bundle origin was 32.1 ± 11.1% posterior (n.s.) and 16.3 ± 9.4% distal (p < 0.01) to the FEA. In ACL-intact knees, the insertion of the AM-bundle was 34.4 ± 6.6% of the tibial plateau depth (n.s.) and 48.1 ± 4.6% of the tibial plateau width (n.s.), whereas the PL-bundle insertion was 42.7 ± 5.4% of the tibial plateau depth (p < 0.01) and 57.1 ± 4.8% of the tibial plateau width (n.s.). CONCLUSION The current study revealed variations in the three-dimensional topographic anatomy of the native ACL between ACL-rupture and ACL-intact knees, which might help surgeons who perform anatomical double-bundle reconstruction surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Dimitris Dimitriou
- Department of Orthopedics, Bürgerspital Solothurn, Schöngrünstrasse 42, Solothurn, 4500, Switzerland
| | - Diyang Zou
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; School of Biomedical Engineering and Med.X Research Institute, Shanghai Jiao Tong University, Shanghai, 200030, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, 200030, Shanghai, China
| | - Zhongzheng Wang
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; School of Biomedical Engineering and Med.X Research Institute, Shanghai Jiao Tong University, Shanghai, 200030, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, 200030, Shanghai, China
| | - Naeder Helmy
- Department of Orthopedics, Bürgerspital Solothurn, Schöngrünstrasse 42, Solothurn, 4500, Switzerland
| | - Tsung-Yuan Tsai
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; School of Biomedical Engineering and Med.X Research Institute, Shanghai Jiao Tong University, Shanghai, 200030, China. .,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, 200030, Shanghai, China.
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Dimitriou D, Zou D, Wang Z, Tsai TY, Helmy N. Anterior root of lateral meniscus and medial tibial spine are reliable intraoperative landmarks for the tibial footprint of anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2021; 29:806-813. [PMID: 32419045 DOI: 10.1007/s00167-020-06018-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The aims of the present study were (1) to investigate the tibial footprint location of the anterior cruciate ligament (ACL) in both ACL-ruptured and ACL-intact patients, (2) to identify the relationship of the tibial footprint to the anterior root of the lateral meniscus (ARLM) and medial tibial spine (MTS), and (3) to evaluate the reliability of the ARLM and MTS for identifying the center of the tibial ACL footprint. METHODS Magnetic resonance images of 90 knees with ACL rupture and 90 matched-controlled knees were used to create three-dimensional models of the tibia. The tibial ACL footprint was outlined on each model, and its location was measured using an anatomical coordinate system. RESULTS No significant difference in the location of the tibial footprint was found between ACL-ruptured and ACL-intact knees. The tibial ACL footprint was located in very close proximity to the ARLM, especially in the M/L direction. The safe zone of tibial tunnel reaming for avoiding damage to the ARLM was 2.6 mm lateral to the center of the native tibial footprint. Both the ARLM and MTS were reliable intraoperative landmarks for identifying the tibial footprint. CONCLUSIONS Orthopedic surgeons should be aware of the safe zone of tibial tunnel reaming for avoiding injury to the ARLM. Both the ARLM and MTS might be reliable landmarks for identifying the center of the tibial ACL footprint and may facilitate tibial tunnel placement during anatomical single-bundle ACL reconstruction, especially in cases of revision where the tibial ACL stump is not available. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Dimitris Dimitriou
- Department of Orthopedics Bürgerspital Solothurn, Schöngrünstrasse 38, CH-4500, Solothurn, Switzerland
| | - Diyang Zou
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Zhongzheng Wang
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Tsung-Yuan Tsai
- Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, 200030, China.
| | - Naeder Helmy
- Department of Orthopedics Bürgerspital Solothurn, Schöngrünstrasse 38, CH-4500, Solothurn, Switzerland
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Dimitriou D, Zou D, Wang Z, Helmy N, Tsai TY. 3T MRI-based anatomy of the anterolateral knee ligament in patients with and without an ACL-rupture: Implications for anatomical anterolateral ligament reconstruction. Knee 2021; 29:390-398. [PMID: 33706030 DOI: 10.1016/j.knee.2021.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/27/2020] [Accepted: 02/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is often accompanied by an injury to the anterolateral ligament (ALL) of the knee. Detailed knowledge of the ALL attachments in ACL-ruptured patients is essential for an anatomical ALL reconstruction to avoid knee over-constraint and successfully treat the residual rotational instability. The aim of the present study was to investigate the three-dimensional (3D), topographic anatomy of the ALL attachment in both ACL-ruptured and ACL-intact patients using 3 Tesla magnetic resonance imaging (3T MRI). METHODS In the present, retrospective case-control study, the magnetic resonance images of 90 knees with an ACL-rupture and 90 matched-controlled subjects, who suffered a non-contact knee injury without an ACL-rupture, were used to create 3D models of the knee. The femoral and tibial ALL footprints were outlined on each model, and their position was measured using an anatomical coordinate system. RESULTS The femoral origin of the ALL was located 4.9 ± 2.8 mm posterior and 3.8 ± 2.4 mm proximal to the lateral epicondyle in a non-isometric location in control subjects. In ACL-ruptured patients, it was located in a more posterior and distal, at 6.0 ± 1.9 mm posterior and 2.4 ± 1.7 mm proximal to the lateral epicondyle (p < 0.01), also in a non-isometric location. No difference was found in the tibial ALL insertion between groups. CONCLUSION The femoral ALL origin was significantly different in ACL-ruptured patients compared to ACL-intact patients. The recommended femoral tunnel position for the anatomical ALL reconstruction, does not represent the femoral ALL origin in the ACL-ruptured knee.
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Affiliation(s)
- Dimitris Dimitriou
- Department of Orthopedics Bürgerspital Solothurn, Schöngrünstrasse 42, CH-4500 Solothurn, Switzerland
| | - Diyang Zou
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, China; Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongzheng Wang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, China; Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Naeder Helmy
- Department of Orthopedics Bürgerspital Solothurn, Schöngrünstrasse 42, CH-4500 Solothurn, Switzerland
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, China; Department of Orthopaedic Surgery, Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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