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Functional Analysis of ACL Insertion Site

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Controversies in the Technical Aspects of ACL Reconstruction

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Abstract

Over the past decade, there has been an increasing interest in anatomic anterior cruciate ligament (ACL) reconstruction. In this book chapter, we review the literature and propose our rationale for the optimal position of the femoral tunnel. Biomechanical, histologic, clinical, and anatomic evidence suggests that the ACL graft should be placed anterior (high) and proximal (deep) within the anatomical femoral footprint as this position (I) is within the anatomical footprint, (II) is at the most isometric position, (III) experiences low graft tension, and (IV) is within the histologic direct load-bearing fibers. Osseous landmarks including the lateral intercondylar ridge and the lateral bifurcate ridge can be used to identify this optimal femoral tunnel location. Both transtibial and anteromedial drilling techniques can be used to place the graft at this tunnel position, but currently there is no clear advantage in one technique over the other.

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Authors and Affiliations

  1. Computer Assisted Surgery Center, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Jelle P. van der List, Danyal H. Nawabi & Andrew D. Pearle

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  1. Jelle P. van der List
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  2. Danyal H. Nawabi
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  3. Andrew D. Pearle
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  1. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

  2. Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy

    Stefano Zaffagnini

  3. Hospital for Special Surgery, New York, New York, USA

    Robert G. Marx

  4. UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA

    Volker Musahl

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van der List, J.P., Nawabi, D.H., Pearle, A.D. (2017). Functional Analysis of ACL Insertion Site. In: Nakamura, N., Zaffagnini, S., Marx, R., Musahl, V. (eds) Controversies in the Technical Aspects of ACL Reconstruction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52742-9_18

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