The Anatomical Study Of Anterior Cruciate Ligament To Tibial Insertion’s Bony Structure

ObjectiveBy dissecting the anterior cruciate ligament stump over the tibial insetion site,to observe the morphological characteristic of the bony structure,then,to provide anatomical evidence of tibial insertion’ s bony structure for anterior cruciate ligament anatomical reconstruction.MethodsA total of 40 resected tibial plateaus gathered from 35 patients who underwent total knee total replacements at the joint orthopaedic departme nt of the first affiliated hospital of Guangzhou university of traditiona 1 medicine during October to December in 2017,3 males,32 females,21 left knee,19 right knee,the average age was 67±7 years,range,54-83 years,to e xpose the bony structure by removing the specimen’s tibial stumps of the anterior cruciate ligament,performing a typical classification according its morphological characteristic;measuring the longth,width,depth,areas,then,comparing the difference of morphological parameters between male an d female;left and right;investigating the areas of anterior cruciate liga ment correlations with height,weight and BMI.ResultsThe study found that,in 40 specimens,anterior cruciate ligament tibial stumps all attached into a bony concave bony structure charactered with 3-dimension,which surrounded by medial and lateral intercondylar ridge,anterior rim and tibial ridge.it was variable in shape,which can be divide into six types:oval,triangular,rectangular,rounded,Elongated and irregular;it revealed 10 oval,5 triangular,8 rectangular,4 rounded,7 elongated,6 irregular,the proportion was 25%,12.5%,20%,10%,17.5%and 15%,respectively;In morphological parameters,the average length,width,depth and areas were 14.0±3.lmm(range,7-20mm),9.2±.9mm(range,3-14mm),9.2±2.9mm(range,3-14mm)and 110.27±28.15mm2(range,64-179mm 2),respectively;the elongated types was charactered with maximal long and depth,minimal width and areas among the six types in morphological parameters;male was greater than female in length and areas,the difference was statistically significant(P<0.05),while the difference in width and depth was not statistically significant(P<0.05);the left and right difference in length,width,depth and areas all showed no statistical significance(P<0.05);the areas of anterior cruciate ligament showed low correlation with height(r=0.303,P=0.058),and no correlation with weight(r=0.059,P=0.717)and BMI(r=-0.095,P=0.559).ConclusionsFor anatomical tibial insertion of ACL reconstruction,clinical surgeon can refer the medial,lateral intercondylar ridge,anterior rim and tibial ridge as bony landmarks,to avoid injure the anterior root of lateral meniscus,medial intercondylar ridge was more safely bony mark in ACL reconstruction surgery:when you refer the tibial ridge as bony landmarks,the tibial tunnel position should be anterior placement slightly;9mm diameters of the size were perfect in term of the tibial bony anatomical structure.while the elongated type of tibial insertion bony structure with special anatomical character than other 5,it demanded special size and morphology in tibial tunnel selection,more clinical research should be performed in future.