The triangle between anterior and posterior cruciate ligaments: arthroscopic anatomy study

Yıl 2015, Cilt: 49 Sayı: 5, 478 - , 24.09.2015

Alper Kaya Murat Koken Burak Akan Berk Guclu

Öz

Objective: The goal of anterior cruciate ligament (ACL) reconstruction is to place the graft in closest proximity to the native ACL anatomy. This study aims to examine the angular relation between intact anterior and posterior cruciate ligaments (PCL) from an arthroscopic perspective.
Methods: Forty patients (20 male, 20 female) with a mean age of 35.12 (range: 18–40) years that underwent knee arthroscopy for reasons other than ACL rupture were included in the study. Following diagnostic examination and repair of the primary pathology, the triangle between ACL and PCL was seen at different flexion degrees of the knee joint (120, 90, 60, and 30°) through standard anterolateral (AL) and anteromedial (AM) portals. The narrow top angle of the triangle between the long intersecting axes of ACL and PCL was measured using recorded images by 3 blind observers.
Results: The average ACL-PCL angle was 61°, (standard deviation±2°) at 90°of knee flexion. The angles were narrower when viewed through the AM portal. The degree of the angles was not affected by age, sex, body mass index (BMI), or the side (right or left) on which the procedure was performed. There was good-to-excellent intra- and interobserver reliability.
Conclusion: The angular relation between intact ACL and PCL has the potential to provide a better view of the anatomy during arthroscopic ACL surgery. To perform better anatomic reconstructions, it is important to create a 60° angle between the ACL graft and PCL (as viewed through AL portal) at 90°of knee flexion.

Anahtar Kelimeler

Anatomy; anterior cruciate ligament; arthroscopy; posterior cruciate ligament; reconstruction; triangle.

Kaynakça

• Colombet P, Robinson J, Christel P, Franceschi JP, Djian P, Bellier G, et al. Morphology of anterior cruciate liga- ment attachments for anatomic reconstruction: a cadav- eric dissection and radiographic study. Arthroscopy 2006;22:984–92.
• Edwards A, Bull AM, Amis AA. The attachments of the anteromedial and posterolateral fibre bundles of the ante- rior cruciate ligament. Part 2: femoral attachment. Knee Surg Sports Traumatol Arthrosc 2008;16:29–36.
• Ferretti M, Levicoff EA, Macpherson TA, Moreland MS, Cohen M, Fu FH. The fetal anterior cruciate liga- ment: an anatomic and histologic study. Arthroscopy 2007;23:278–83.
• Luites JW, Wymenga AB, Blankevoort L, Kooloos JG. De- scription of the attachment geometry of the anteromedial and posterolateral bundles of the ACL from arthroscopic perspective for anatomical tunnel placement. Knee Surg Sports Traumatol Arthrosc 2007;15:1422–31.
• Mochizuki T, Muneta T, Nagase T, Shirasawa S, Akita KI, Sekiya I. Cadaveric knee observation study for de- scribing anatomic femoral tunnel placement for two-bun- dle anterior cruciate ligament reconstruction. Arthroscopy 2006;22:356–61.
• Siebold R, Ellert T, Metz S, Metz J. Femoral insertions of the anteromedial and posterolateral bundles of the an- terior cruciate ligament: morphometry and arthroscopic orientation models for double-bundle bone tunnel place- ment--a cadaver study. Arthroscopy 2008;24:585–92.
• Siebold R, Ellert T, Metz S, Metz J. Tibial insertions of the anteromedial and posterolateral bundles of the ante- rior cruciate ligament: morphometry, arthroscopic land- marks, and orientation model for bone tunnel placement. Arthroscopy 2008;24:154–61.
• Takahashi M, Doi M, Abe M, Suzuki D, Nagano A. Ana- tomical study of the femoral and tibial insertions of the anteromedial and posterolateral bundles of human ante- rior cruciate ligament. Am J Sports Med 2006;34:787–92.
• Tansatit T, Saowaprut S, Kanchanatawan W, Chom- kerd T. Pattern of angular change of the anterior cruciate ligament across the range of knee flexion and the related anatomical dimensions. J Med Assoc Thai 2005;88 Suppl 4:95–102.
• Tsukada H, Ishibashi Y, Tsuda E, Fukuda A, Toh S. Ana- tomical analysis of the anterior cruciate ligament femoral and tibial footprints. J Orthop Sci 2008;13:122–9.
• Lawhorn K, Howell SM. Avoiding ACL graft impinge- ment: principles for tunnel placement using the transtibial tunnel technique. In Jackson DW, editor. Master Tech- niques in orthopaedic surgery:reconstructive knee surgery. Philadelphia:Lippincott Williams & Williams 2008.
• Longino D, Clerck N, Fowler PJ, Giffin JR. Technique in ACL reconstruction: hamstring reconstruction. In Bonnin M et al. editors. The Knee Joint. Surgical techniques and strategies. Paris: Springer-Verlag 2012;17:195–202.
• Musahl V, Plakseychuk A, VanScyoc A, Sasaki T, Debski RE, McMahon PJ, et al. Varying femoral tunnels between the anatomical footprint and isometric positions: effect on kinematics of the anterior cruciate ligament-reconstructed knee. Am J Sports Med 2005;33:712–8.
• Zantop T, Diermann N, Schumacher T, Schanz S, Fu FH, Petersen W. Anatomical and nonanatomical double- bundle anterior cruciate ligament reconstruction: impor- tance of femoral tunnel location on knee kinematics. Am J Sports Med 2008;36:678–85.
• Harner CD, Baek GH, Vogrin TM, Carlin GJ, Kashiwa- guchi S, Woo SL. Quantitative analysis of human cruciate ligament insertions. Arthroscopy 1999;15:741–9.
• Heming JF, Rand J, Steiner ME. Anatomical limitations of transtibial drilling in anterior cruciate ligament recon- struction. Am J Sports Med 2007;35:1708–15.
• Noyes FR. The function of the human anterior cruciate ligament and analysis of single- and double-bundle graft reconstructions. Sports Health 2009;1:66–75.
• Bedi A, Altchek DW. The “footprint” anterior cruciate liga- ment technique: an anatomic approach to anterior cruciate ligament reconstruction. Arthroscopy 2009;25:1128–38.
• Sastre S, Popescu D, Nşñez M, Pomes J, Tomas X, Peidro L. Double-bundle versus single-bundle ACL reconstruc- tion using the horizontal femoral position: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 2010;18:32–6.
• Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL. Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o’clock and 10 o’clock femoral tunnel placement. 2002 Richard O’Connor Award paper. Arthroscopy 2003;19:297–304.