2017 ISAKOS Biennial Congress ePoster #1133

 

A Systematic Review Of Anterior Cruciate Ligament Femoral Footprint Location Evaluated By Quadrant Method For Single-Bundle And Double-Bundle Anatomic Reconstruction

Hu Xu, MD, Xi’An, CHINA
Chunli Zhang, Xi’An , Shannxi CHINA
Qiang Zhang, MD, Hefei CHINA
Tianshu Du, MD, Xi'an CHINA
Ming Ding, MD, Xi'an CHINA
Yingchun Wang, MD, Xi'an CHINA
Sai-Chuen Fu, PhD, Hong Kong HONG KONG
Chelsea Hopkins, BSc, Hong Kong HONG KONG
Patrick S. H. Yung, MBChB, FRCS(Orth), FHKCOS, FHKAM, FRCS, Shatin, New Territories HONG KONG
Kai-Ming Chan, MBBS, MCh(Orth), FRCPS(G), FRCS(E), FRCSEd(Orth) HONG KONG

Institution of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi, CHINA

FDA Status Not Applicable

Summary

In this systematic review of ACL anatomic studies, combined data unravel the standard position of ACL femoral origin, which can be utilized by clinicians to localize anatomical tunnel both in surgery and post-surgical evaluation.

Abstract

Purpose

This review aims to unravel the standard position of anterior cruciate ligament (ACL) femoral origin and deduce practical arthroscopic localization and post-surgical evaluation method.

Methods

Two independent reviewers searched PubMed using the terms, “ACL”, “footprint”, “femur”, etc. We included studies published since January 1, 2000, in which the results were measured by Bernard’s quadrant method. This method consists of four distances, including total diameter of lateral condyle along Blumensaat’s line (distance t), maximum intercondylar notch height (distance h), distance from center of footprint to proximal border (distance x), and distance from center of footprint to Blumensaat’s line (distance y). The data of included studies were combined to calculate theoretical centers and standard area for both ACL as a whole bundle and as anteromedial (AM) and posterolateral (PL) bundles, individually. Finally, we translated the combined data to arthroscopic localization and post-surgical evaluation.

Results

A total of 13 studies were included. The theoretical centers of ACL as a whole bundle is 28.4±5.1% (x) of distance t, 35.7±6.9% (y) of distance h, whereas AM bundle is 24.2±4%, 21.6±5.2% (x, y), and PL bundle is 32.8±4.7%, 46.7±4.9% (x, y), respectively. The standard area of ACL footprint is a circle with a center of 27.53%, 35.85% (x, y), and a radius of 4.58%, 9.2% (x, y), respectively. Translation of combined data demonstrates that under arthroscopy, for single-bundle ACL reconstruction, the midpoint of distance from border of proximal to distal articular cartilage is the center of anatomic femoral socket.

Conclusions

Combined data unravel the standard position of ACL femoral origin. It can be utilized by clinicians to localize anatomical tunnel both in surgery and post-surgical evaluation. For single-bundle ACL reconstruction, the midpoint of lateral femoral condyle corresponds to anatomic socket.
Level of Evidence: Level V, systematic review of anatomic studies.

This paper has been published in Arthroscopy in 2016 (ePub).