Applied Anatomy Study And Clinical Application Of The Anterior Cruciate Ligament Femoral Attachment

Part Ⅰ Applied Anatomy Study of the Anterior CruciateLigament femoral attachmentObjective: Investigate anatomical features of the anterior cruciate ligament (ACL)femoral attachment and provide anatomy evidence for clinical application.Method: Fourteen cases of formalin-fixed knee joints were taken from cadavers anddetached. The surrounding muscles, joint capsules and patellae were removed, and thecollateral ligaments, cruciate ligaments and menisci were retained. The femora werechopped into two parts with a fret saw along the sagittal plane through the highest point ofthe exit in front of the intercondylar fossa to reveal the inner side of the lateral femoralcondyle, fully revealing the ACL femoral attachment and its associated bony landmarks.The distributions of the anteromedial and posterolateral bundles femoral attachment,the leading edge point of intercondylar fossa and over-the-top point were separated andmarked with an oil pen. The lateral photos were taken by a high-definition digital cameraand then imported into a computer for measurement of the following indicators:①imprinted centre,②long imprinted axis L1,③short imprinted axis L2,④the distanceof dual-bundles center points (AP),⑤the distance between the The anteromedialbundle(AMB) imprinted centre point and the over-the-top point (AO),⑥the closestdistance between the AMB imprinted centre point and the posterior edge of the distalfemoral cartilage (AI),⑦the closest distance of the posterolateral bundle (PLB)imprinted center point and the posterior edge of the distal femoral cartilage (PI),⑧ACLarea (S),⑨Blumensaat length (B).⑩the distance between the ACL imprinted centrepoint and the over-the-top point (CO), the closest distance between the ACL imprintedcentre point and the posterior edge of the distal femoral cartilage (CI). Based on above,while in the reconstruction of ACL, the positioning reference data of the femoral attachment were determined and analyzed for determining whether the data werecorrelated to each other.Results: Long imprinted axis (L1):17.5±1.65mm， short imprinted axis (L2):8.79±1.11mm, ACL area (S):96.52±17.84mm2, the distance of dual-bundles centerpoints (AP):9.00±0.72mm, the distance between the AMB imprinted centre point andthe over-the-top (AO):8.03±2.20mm，the closest distance between the AMB imprintedcentre point and the posterior edge of the distal femoral cartilage (AI):6.17±1.82mm，theclosest distance of PLB imprinted center point and the posterior edge of the distal femoralcartilage (PI):8.92±1.43mm，Blumensaat length (B):30.47±1.46mm, imprinted centre:25.53±5.49°, the distance between the ACL imprinted centre point and the over-the-top(CO):9.42±2.18mm、the closest distance between the ACL imprinted centre point and theposterior edge of the distal femoral cartilage (CI):7.59±1.54. ACL femoral attachmentarea was in an irregular shape, in which79%was oval,7%was crescent-shaped, and14%was round. However, most of them could be approximately judged as ellipse. Statisticalanalysis shows:L1, AP, PI, B, imprinted centre, CO, AO, AI, CI are statisticallysignificant base on gender difference（P=0.001、P=0.013、P=0.033、P=0.003、P=0.002、P=0.046、P=0.002、P=0.019、P=0.021）. L2, S are not statistically significant base onGender difference（P=0.954、P=0.062）. All data are not statistically significant base on leftor right（P>0.05）. Correlation of L1and B（R=0.921P=0.000）. Correlation of AOand B（R=0.558P=0.038）. Correlation of CO and B（R=0.912P=0.000）. NOcorrelation of AP and A（IR=0.415P=0.140）. NO correlation of AP and P（IR=0.463P=0.095）. NO correlation of AP and CI（R=0.400P=0.156）. Correlation of AI and PI（R=0.965P=0.000）. Correlation of AI and CI（R=0.944P=0.000）. Correlation ofCI and PI（R=0.939，P=0.000）.Conclusion: ACL femoral attachment area was in an irregular shape, in which79%was oval,7%was crescent-shaped, and14%was round. However, most of them could beapproximately judged as ellipse. While in ACL double-bundle reconstruction, the centerpoint of the AMB femoral tunnel should be8.86±0.73mm (male)/6.54±1.56mm(female) apart from the over-the-top and6.68±1.06mm(male)/5.05±0.68mm (female)apart from the posterior edge of the distal femoral cartilage; the center point of the PLBfemoral tunnel should be9.33±0.60mm (male)/8.40±0.52mm (female) apart from thecenter point of the AMB femoral tunnel and9.51±1.22mm (male)/7.86±1.23mm (female) apart from the posterior edge of the distal femoral cartilage. While in ACLsingle-bundle reconstruction, the center point of the femoral tunnel should be10.26±1.69mm (male)/7.89±0.46mm (female) apart from the over-the-top and8.11±1.03mm (male)/6.65±0.87mm (female) apart from the posterior edge of the distal femoral cartilage. Part Ⅱ Clinical application of the Anterior CruciateLigament femoral attachmentObjective: To study the clinical curative effect of hamstring tendon autograft forthe Anterior Cruciate Ligament femoral attachment anatomical reconstruction.Methods:19patients with ACL injury were given single bunch ACL reconstructionunder arthroscopy according to the data from the research. In all the operations, suspensorysingle bunch with double tunnels was adopted for ACL reconstruction under arthroscopywith hamstring tendons as transplant. IKDC, Tegner and Lysholm scores before and afterthe surgery were evaluated. Statistical analysis was used for the relevant data.Results: Wounds of all the19patients were healed in the first term, and nopostoperative complications were seen. Postoperative follow-up lasted6~17months, withan average of12months. Knee extension was unlimited in the19patients, and the activityof knee flexion was normal. IKDC, Tegner and Lysholm scores were significantlyimproved when compared to the preoperative one.Conclusion: Reference to the over-the-top and the posterior edge of the distal femoralcartilage to position the femoral tunnel, it is convenient and accurate to conductarthroscopic reconstruction ACL. The results are conformed to the anatomicalreconstruction of ACL and physiological function. After surgery, the knee joint functionswere well recovered, which was an ideal method for positioning.