The Journal of Bone and Joint Surgery, Vol 67, Issue 2 257-262, Copyright © 1985 by Journal of Bone and Joint Surgery, Inc

JOURNAL CONTENTS

Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction

M Odensten and J Gillquist

In thirty-three normal cadaver knees from adults (mean age, twenty-nine years), the average length of the anterior cruciate ligament was 31 +/- 3 millimeters and the angle between the ligament and the long axis of the femur was 28 +/- 4 degrees with the knee at 90 degrees of flexion. We could find no macroscopic or microscopic evidence of discrete subdivisions of the anterior cruciate ligament. We studied the functional importance of the positions of the attachments of the anterior cruciate ligament. The distance between the central points of the normal attachment areas on the tibia and on the femur was found to be isometric during flexion and extension. The so-called over-the-top position on the femur was the least favorable of the positions that we tested, since it resulted in an average elongation of the ligament of ten millimeters with the knee in full extension as compared with full flexion. On the basis of the results in the present study, we suggest some basic principles for a standardized replacement operation for a deficient anterior cruciate ligament.
CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				L. D. Farrow, R. J. Gillespie, B. N. Victoroff, and D. R. Cooperman Radiographic Location of the Lateral Intercondylar Ridge: Its Relationship to Blumensaat's Line Am. J. Sports Med., October 1, 2008; 36(10): 2002 - 2006. [Abstract] [Full Text] [PDF]

				N. Saupe, L. M. White, M. M. Chiavaras, J. Essue, I. Weller, M. Kunz, M. Hurtig, and P. Marks Anterior Cruciate Ligament Reconstruction Grafts: MR Imaging Features at Long-term Follow-up--Correlation with Functional and Clinical Evaluation Radiology, September 3, 2008; (2008) 2492071651. [Abstract] [Full Text]

				F. H. Fu, W. Shen, J. S. Starman, N. Okeke, and J. J. Irrgang Primary Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction: A Preliminary 2-Year Prospective Study Am. J. Sports Med., July 1, 2008; 36(7): 1263 - 1274. [Abstract] [Full Text] [PDF]

				M. E. Steiner, M. M. Murray, and S. A. Rodeo Strategies to Improve Anterior Cruciate Ligament Healing and Graft Placement Am. J. Sports Med., January 1, 2008; 36(1): 176 - 189. [Abstract] [Full Text] [PDF]

				T. Zantop, M. Wellmann, F. H. Fu, and W. Petersen Tunnel Positioning of Anteromedial and Posterolateral Bundles in Anatomic Anterior Cruciate Ligament Reconstruction: Anatomic and Radiographic Findings Am. J. Sports Med., January 1, 2008; 36(1): 65 - 72. [Abstract] [Full Text] [PDF]

				F. Mauch, G. Apic, U. Becker, and G. Bauer Differences in the Placement of the Tibial Tunnel During Reconstruction of the Anterior Cruciate Ligament With and Without Computer-Assisted Navigation Am. J. Sports Med., November 1, 2007; 35(11): 1824 - 1832. [Abstract] [Full Text] [PDF]

				L. D. Farrow, M. R. Chen, D. R. Cooperman, B. N. Victoroff, and D. B. Goodfellow Morphology of the Femoral Intercondylar Notch J. Bone Joint Surg. Am., October 1, 2007; 89(10): 2150 - 2155. [Abstract] [Full Text] [PDF]

				J. F. Heming, J. Rand, and M. E. Steiner Anatomical Limitations of Transtibial Drilling in Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., October 1, 2007; 35(10): 1708 - 1715. [Abstract] [Full Text] [PDF]

				S. Plaweski, J. Cazal, P. Rosell, and P. Merloz Anterior Cruciate Ligament Reconstruction Using Navigation: A Comparative Study on 60 Patients Am. J. Sports Med., April 1, 2006; 34(4): 542 - 552. [Abstract] [Full Text] [PDF]

				M. P. Arnold, N. Verdonschot, and A. van Kampen The Normal Anterior Cruciate Ligament as a Model for Tensioning Strategies in Anterior Cruciate Ligament Grafts Am. J. Sports Med., February 1, 2005; 33(2): 277 - 283. [Abstract] [Full Text] [PDF]

				C. K. Yiannakopoulos, M. Mowbray, and A. F. Anderson Transepiphyseal Replacement of the Anterior Cruciate Ligament in Skeletally Immature Patients. A Preliminary Report * A.F. Anderson replies: J. Bone Joint Surg. Am., March 1, 2004; 86(3): 648 - 649. [Full Text] [PDF]

				A. D. Armstrong, L. M. Ferreira, C. E. Dunning, J. A. Johnson, and G. J. W. King The Medial Collateral Ligament of the Elbow Is Not Isometric: An In Vitro Biomechanical Study Am. J. Sports Med., January 1, 2004; 32(1): 85 - 90. [Abstract] [Full Text]

				A. F. Anderson Transepiphyseal Replacement of the Anterior Cruciate Ligament in Skeletally Immature Patients: A Preliminary Report J. Bone Joint Surg. Am., July 3, 2003; 85(7): 1255 - 1263. [Abstract] [Full Text] [PDF]

				S. M. Howell, M. P. Wallace, M. L. Hull, and M. L. Deutsch Evaluation of the Single-Incision Arthroscopic Technique for Anterior Cruciate Ligament Replacement: A Study of Tibial Tunnel Placement, Intraoperative Graft Tension, and Stability Am. J. Sports Med., May 1, 1999; 27(3): 284 - 293. [Abstract] [Full Text] [PDF]

				T. A. Mann, K. P. Black, D. J. Zanotti, M. Barr, and T. Teater The Natural History of the Intercondylar Notch After Notchplasty Am. J. Sports Med., March 1, 1999; 27(2): 181 - 188. [Abstract] [Full Text] [PDF]

				J. P. Furia, D. M. Lintner, P. Saiz, H. W. Kohl, and P. Noble Isometry Measurements in the Knee With the Anterior Cruciate Ligament Intact, Sectioned, and Reconstructed Am. J. Sports Med., June 1, 1997; 25(3): 346 - 352. [Abstract] [PDF]

				D.C. Covey, A. A. Sapega, and G. M. Sherman Testing for Isometry During Reconstruction of the Posterior Cruciate Ligament: Anatomic and Biomechanical Considerations Am. J. Sports Med., December 1, 1996; 24(6): 740 - 746. [Abstract] [PDF]

				R. L. Hole, D. M. Lintner, E. Kamaric, and J. B. Moseley Increased Tibial Translation After Partial Sectioning of the Anterior Cruciate Ligament: The Posterolateral Bundle Am. J. Sports Med., July 1, 1996; 24(4): 556 - 560. [Abstract] [PDF]

				L. C. S. M. HOWELL and C. M. A. TAYLOR Brace-Free Rehabilitation, with Early Return to Activity, for Knees Reconstructed with a Double-Looped Semitendinosus and Gracilis Graft*{{dagger}} J. Bone Joint Surg. Am., June 1, 1996; 78(6): 814 - 25. [Abstract] [Full Text]

				E. E. Khalfayan, P. F. Sharkey, A. H. Alexander, J. D. Bruckner, and E. B. Bynum The Relationship Between Tunnel Placement and Clinical Results After Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., June 1, 1996; 24(3): 335 - 341. [Abstract] [PDF]

				T. S. Samuelson, D. Drez Jr., and G. B. Maletis Anterior Cruciate Ligament Graft Rotation: Reproduction of Normal Graft Rotation Am. J. Sports Med., January 1, 1996; 24(1): 67 - 71. [Abstract] [PDF]

				D. M. Lintner, S. E. Dewitt, and J. B. Moseley Radiographic Evaluation of Native Anterior Cruciate Ligament Attachments and Graft Placement for Reconstruction: A Cadaveric Study Am. J. Sports Med., January 1, 1996; 24(1): 72 - 78. [Abstract] [PDF]

				C. D. Harner, J. W. Xerogeanes, G. A. Livesay, G. J. Carlin, B. A. Smith, T. Kusayama, S. Kashiwaguchi, and S. L.-Y. Woo The Human Posterior Cruciate Ligament Complex: An Interdisciplinary Study: Ligament Morphology and Biomechanical Evaluation Am. J. Sports Med., December 1, 1995; 23(6): 736 - 745. [Abstract] [PDF]

				M. F. Blum, W. P. Garth JR., and J. E. Lemons The Effects of Graft Rotation on Attachment Site Separation Distances in Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., June 1, 1995; 23(3): 282 - 287. [Abstract] [PDF]

				S. M. Howell and S. J. Barad Knee Extension and its Relationship to the Slope of the Intercondylar Roof: Implications for Positioning the Tibial Tunnel in Anterior Cruciate Ligament Reconstructions Am. J. Sports Med., June 1, 1995; 23(3): 288 - 294. [Abstract] [PDF]

				J. A. Karlson, M. E. Steiner, C. H. Brown, and J. Johnston Anterior Cruciate Ligament Reconstruction Using Gracilis and Semitendinosus Tendons: Comparison of Through-the-condyle and Over-the-top Graft Placements Am. J. Sports Med., September 1, 1994; 22(5): 659 - 666. [Abstract] [PDF]

				M. D. Santi and A. B. Richardson The Ligament Augmentation Device in Hamstring Grafts for Reconstruction of the Anterior Cruciate Ligament Am. J. Sports Med., July 1, 1994; 22(4): 524 - 530. [Abstract] [PDF]

				R. F. LaPrade and Q. M. Burnett II Femoral Intercondylar Notch Stenosis and Correlation to Anterior Cruciate Ligament Injuries: A Prospective Study Am. J. Sports Med., March 1, 1994; 22(2): 198 - 203. [Abstract] [PDF]

				R. J. Herzog, J. F. Silliman, K. Hutton, W. G. Rodkey, and J. R. Steadman Measurements of the Intercondylar Notch by Plain Film Radiography and Magnetic Resonance Imaging Am. J. Sports Med., March 1, 1994; 22(2): 204 - 210. [Abstract] [PDF]

				M. R. Colville and R. R. Bowman The significance of isometer measurements and graft position during anterior cruciate ligament reconstruction Am. J. Sports Med., December 1, 1993; 21(6): 832 - 835. [Abstract] [PDF]

				C. H. Brown JR, A. T. Hecker, J. A. Hipp, E. R. Myers, and W. C. Hayes The biomechanics of interference screw fixation of patellar tendon anterior cruciate ligament grafts Am. J. Sports Med., December 1, 1993; 21(6): 880 - 886. [Abstract] [PDF]

				D. J. Raab, D. A. Fischer, J. P. Smith, A. W. Markman, and J. A. Steubs Comparison of arthroscopic and open reconstruction of the anterior cruciate ligament: Early results Am. J. Sports Med., September 1, 1993; 21(5): 680 - 684. [Abstract] [PDF]

				S. E. Fisher and K. D. Shelbourne Arthroscopic treatment of symptomatic extension block complicating anterior cruciate ligament reconstruction Am. J. Sports Med., July 1, 1993; 21(4): 558 - 564. [Abstract] [PDF]

				J. Gillquist and M. Odensten Reconstruction of old anterior cruciate ligament tears with a Dacron prosthesis: A prospective study Am. J. Sports Med., June 1, 1993; 21(3): 358 - 366. [Abstract] [PDF]

				V. M. Romano, B. K. Graf, J. S. Keene, and R. H. Lange Anterior cruciate ligament reconstruction: The effect of tibial tunnel placement on range of motion Am. J. Sports Med., June 1, 1993; 21(3): 415 - 418. [Abstract] [PDF]

				T. Muneta, H. Yamamoto, H. Sakai, T. Ishibashi, and K. Furuya Relationship between changes in length and force in in vitro reconstructed anterior cruciate ligament Am. J. Sports Med., March 1, 1993; 21(2): 299 - 304. [Abstract] [PDF]

				B. Fleming, B. D. Beynnon, R. J. Johnson, W. D. McLeod, and M. H. Pope Isometric versus tension measurements Am. J. Sports Med., January 1, 1993; 21(1): 82 - 88. [Abstract] [PDF]

				R. S. Brower, A. Melby, M. J. Askew, and D. C. Beringer In vitro comparison of over-the-top and through-the-condyle anterior cruciate ligament reconstructions Am. J. Sports Med., September 1, 1992; 20(5): 567 - 574. [Abstract] [PDF]

				N. C. Yaru, D. M. Daniel, and D. Penner The effect of tibial attachment site on graft impingement in an anterior cruciate ligament reconstruction Am. J. Sports Med., March 1, 1992; 20(2): 217 - 220. [Abstract] [PDF]

				H. Kurosawa, K. Yasuda, K.-I. Yamakoshi, A. Kamiya, and K. Kaneda An experimental evaluation of isometric placement for extraarticular reconstructions of the anterior cruciate ligament Am. J. Sports Med., July 1, 1991; 19(4): 384 - 388. [Abstract] [PDF]

				S. M. Howell, J. A. Clark, and T. E. Farley A rationale for predicting anterior cruciate graft impingement by the intercondylar roof: A magnetic resonance imaging study Am. J. Sports Med., June 1, 1991; 19(3): 276 - 282. [Abstract] [PDF]

				S. M. Howell, J. A. Clark, and R. D. Blasier Serial magnetic resonance imaging of hamstring anterior cruciate ligament autografts during the first year of implantation: A preliminary study Am. J. Sports Med., January 1, 1991; 19(1): 42 - 47. [Abstract] [PDF]

				C. J. Wirth and D. Kohn Reconstruction of the anterior cruciate ligament: A new positioning and fixation technique Am. J. Sports Med., March 1, 1990; 18(2): 154 - 159. [Abstract] [PDF]

				R. E. Hunter, W. D. Lew, J. L. Lewis, C. Kowalczyk, and W. Settle Graft force-setting technique in reconstruction of the anterior cruciate ligament Am. J. Sports Med., January 1, 1990; 18(1): 12 - 19. [Abstract] [PDF]

				L. F. Draganich, B. Reider, and P. R. Miller An in vitro study of the Muller anterolateral femorotibial ligament tenodesis in the anterior cruciate ligament deficient knee Am. J. Sports Med., June 1, 1989; 17(3): 357 - 362. [Abstract] [PDF]

				E. S. Grood, M. S. Hefzy, and T. N. Lindenfield Factors affecting the region of most isometric femoral attachments: Part I: The posterior cruciate ligament Am. J. Sports Med., March 1, 1989; 17(2): 197 - 207. [Abstract] [PDF]

				M. S. Hefzy, E. S. Grood, and F. R. Noyes Factors affecting the region of most isometric femoral attachments: Part II: The anterior cruciate ligament Am. J. Sports Med., March 1, 1989; 17(2): 208 - 216. [Abstract] [PDF]

				R. Nisell, M. O. Ericson, G. Nemeth, and J. Ekholm Tibiofemoral joint forces during isokinetic knee extension Am. J. Sports Med., January 1, 1989; 17(1): 49 - 54. [Abstract] [PDF]

				D. A. Penner, D. M. Daniel, P. Wood, and D. Mishra An in vitro study of anterior cruciate ligament graft placement and isometry Am. J. Sports Med., June 1, 1988; 16(3): 238 - 243. [Abstract] [PDF]

				M. Odensten, J. Lysholm, and J. Gillquist The course of partial anterior cruciate ligament ruptures Am. J. Sports Med., June 1, 1985; 13(3): 183 - 186. [Abstract] [PDF]