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Anterior root of lateral meniscus and medial tibial spine are reliable intraoperative landmarks for the tibial footprint of anterior cruciate ligament

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aims of the present study were (1) to investigate the tibial footprint location of the anterior cruciate ligament (ACL) in both ACL-ruptured and ACL-intact patients, (2) to identify the relationship of the tibial footprint to the anterior root of the lateral meniscus (ARLM) and medial tibial spine (MTS), and (3) to evaluate the reliability of the ARLM and MTS for identifying the center of the tibial ACL footprint.

Methods

Magnetic resonance images of 90 knees with ACL rupture and 90 matched-controlled knees were used to create three-dimensional models of the tibia. The tibial ACL footprint was outlined on each model, and its location was measured using an anatomical coordinate system.

Results

No significant difference in the location of the tibial footprint was found between ACL-ruptured and ACL-intact knees. The tibial ACL footprint was located in very close proximity to the ARLM, especially in the M/L direction. The safe zone of tibial tunnel reaming for avoiding damage to the ARLM was 2.6 mm lateral to the center of the native tibial footprint. Both the ARLM and MTS were reliable intraoperative landmarks for identifying the tibial footprint.

Conclusions

Orthopedic surgeons should be aware of the safe zone of tibial tunnel reaming for avoiding injury to the ARLM. Both the ARLM and MTS might be reliable landmarks for identifying the center of the tibial ACL footprint and may facilitate tibial tunnel placement during anatomical single-bundle ACL reconstruction, especially in cases of revision where the tibial ACL stump is not available.

Level of Evidence

Level III.

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Funding

This project was sponsored by the National Natural Science Foundation of China (31771017, 31972924), the Science and Technology Commission of Shanghai Municipality (16441908700), the Innovation Research Plan supported by Shanghai Municipal Education Commission (ZXWF082101), the National Key R&D Program of China (2017YFC0110700, 2019YFC0120600), and Shanghai Jiao Tong University (ZH2018QNA06, YG2017MS09).

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Author notes

  1. Dimitris Dimitriou and Diyang Zou contributed equally to this article.

Authors and Affiliations

  1. Department of Orthopedics Bürgerspital Solothurn, Schöngrünstrasse 38, CH-4500, Solothurn, Switzerland

    Dimitris Dimitriou & Naeder Helmy

  2. Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine; School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, 200030, China

    Diyang Zou, Zhongzheng Wang & Tsung-Yuan Tsai

Authors
  1. Dimitris Dimitriou
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  2. Diyang Zou
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  4. Tsung-Yuan Tsai
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  5. Naeder Helmy
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Corresponding author

Correspondence to Tsung-Yuan Tsai.

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The authors of this manuscript have nothing to disclose that would bias our work.

Ethical approval

The present single-center, retrospective study was approved by the institutional Internal Review Boards and ethical committees (Ethics Committee Northeast and Central Switzerland 2018-01410) of the authors.

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Dimitriou, D., Zou, D., Wang, Z. et al. Anterior root of lateral meniscus and medial tibial spine are reliable intraoperative landmarks for the tibial footprint of anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 29, 806–813 (2021). https://doi.org/10.1007/s00167-020-06018-0

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  • DOI: https://doi.org/10.1007/s00167-020-06018-0

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