Purpose

The purpose of this systematic review was to review the anatomical reports concerning the anterior cruciate ligament (ACL) focusing on the mid-substance insertion and fan-like extension fibers, or direct and indirect insertions.

Methods

Following the PRISMA, data collection was performed. PubMed, Web of Science, and the Cochran library were searched with the terms “anterior cruciate ligament reconstruction”, “anatomy”, and “cadaver”. Studies were included when anatomical dissection of the ACL with cadavers was performed. Biomechanical studies without a detailed description of the anatomical dissection, reviews, and studies not including pictures of the anatomical specimens were excluded from this study. In the full article review, documentation of the mid-substance insertion and fan-like extension fibers, or direct and indirect insertions in the ACL morphology was evaluated in detail.

Results

Fifty-seven studies were included for detailed evaluation. In 2006, Mochizuki et al. reported a macroscopic differentiation between the mid-substance insertion and fan-like extension fibers in the ACL footprint. In 2010, Iwahashi et al. detected the existence of direct and indirect insertions within the femoral ACL footprint, microscopically. Following Mochizuki’s report, anatomical evaluation of the mid-substance insertion and fan-like extension fibers, or direct and indirect insertions was reported in 16 of 51 ACL anatomical studies. In studies focusing on the morphology of the ACL, 16 of 28 studies addressed this subject. In these studies, the mid-substance insertion and fan-like extension fibers were differentiated macroscopically, and the direct and indirect insertions were differentiated microscopically within the ACL footprint. Fan-like extension fibers or indirect insertion was reported to surround the mid-substance insertion or direct insertion within the femoral ACL footprint.

Conclusions

The results of this systematic review showed that, the existence of the mid-substance insertion and fan-like extension fibers, or direct and indirect insertions in ACL morphology is being recognized more widely. These structures should be taken into consideration when surgeons perform ACL surgery.

Level of Evidence

III. Systematic review of Level-III studies.

中文翻译：

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前十字韧带解剖尸体研究的系统回顾，重点关注中间物质插入和扇状延伸纤维

目的

本系统综述的目的是回顾有关前十字韧带 (ACL) 的解剖学报告，重点关注中间物质插入和扇状延伸纤维，或直接和间接插入。

方法

在 PRISMA 之后，进行数据收集。使用“前十字韧带重建”、“解剖学”和“尸体”等术语搜索了 PubMed、Web of Science 和 Cochran 图书馆。当用尸体对 ACL 进行解剖学时，研究就被纳入其中。没有详细描述解剖解剖的生物力学研究、评论和不包括解剖标本图片的研究被排除在本研究之外。在完整的文章评论中，详细评估了 ACL 形态中的中间物质插入和扇状延伸纤维或直接和间接插入的记录。

结果

纳入了 57 项研究进行详细评估。2006 年，望月月等人。报道了 ACL 足迹中的中间物质插入和扇状延伸纤维之间的宏观差异。2010 年，Iwahashi 等人。在显微镜下检测到股骨 ACL 足迹内是否存在直接和间接插入。根据 Mochizuki 的报告，在 51 项 ACL 解剖研究中，有 16 项报告了对中间物质插入和扇状延伸纤维或直接和间接插入的解剖学评估。在关注 ACL 形态的研究中，28 项研究中有 16 项涉及这一主题。在这些研究中，中间物质插入和扇状延伸纤维在宏观上有所区别，直接和间接插入在 ACL 足迹内在微观上有所区别。据报道，扇状延伸纤维或间接插入围绕股骨 ACL 足迹内的中间物质插入或直接插入。

结论

本系统综述的结果表明，ACL形态中的中间物质插入和扇状延伸纤维，或直接和间接插入的存在正在得到更广泛的认识。外科医生进行 ACL 手术时应考虑这些结构。

证据水平

三．III 级研究的系统回顾。