title: The arrangement and the attachment areas of three ACL bundles.
abstract: OBJECTIVE
  Normal anterior cruciate ligament (ACL) can be divided into three fiber bundles-i.e., anteromedial (AM), intermediate (IM), and posterolateral (PL) bundles. However, their arrangement and attachment areas had remained unclear. The purpose of this study was to clarify the arrangement of these three ACL fiber bundles and their attachment sites, and to provide information on the tunnel placement in anatomical triple bundle ACL reconstruction.
  
  
  METHODS
  Seven non-embalmed human frozen knees were used. ACL fibers were bluntly divided into three bundles. A different-colored thread was wound around each fiber bundle in a spiral. Macroscopical investigation was performed to clarify the arrangement of three ACL bundles. Each fiber bundle was carefully detached from the femur and tibia, and then the distribution of attachment sites of each fiber bundle was observed.
  
  
  RESULTS
  In knee extension, all bundles consisting of AM, IM and PL bundles ran parallel to each other in the lateral view from the medial side. The AM bundle overlapped with the IM bundle, whereas the PL bundle ran parallel to them on the distal aspects. As the knee flexion increased, the bundles became twisted around each other. On the tibial side, the attachment areas of three fiber bundles formed a triangular shape showing arrangements of AM, IM and PL bundles on the anteromedial, anterolateral and posterior aspects, respectively. On the femoral side, the PL bundle was attached on the distal-posterior areas; the IM bundle was attached distal-anterior to the AM bundle. They were arranged in a triangular shape on the tibia side as well.
  
  
  CONCLUSIONS
  This study clarified the arrangement of three fiber bundles of ACL and detailed geographical locations of their attachment sites. The detailed anatomic description of the natural ACL attachment might suggest to surgeons where to make tunnels during anatomical double/triple bundle ACL reconstruction.
authors.affiliation: Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, S1-w16 Chu-ou-ku, Sapporo, 060-8543, Japan. otsubo-orth@umin.ac.jp
authors.forename: Hidenori
authors.initials: H
authors.lastname: Otsubo
authors.forename: Konsei
authors.initials: K
authors.lastname: Shino
authors.forename: Daisuke
authors.initials: D
authors.lastname: Suzuki
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kamiya
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Suzuki
authors.forename: Kota
authors.initials: K
authors.lastname: Watanabe
authors.forename: Mineko
authors.initials: M
authors.lastname: Fujimiya
authors.forename: Takehiko
authors.initials: T
authors.lastname: Iwahashi
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Yamashita
mesh_terms: D016118:Anterior Cruciate Ligament / Q000033:anatomy & histology* / Q000502:physiology / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction; D005260:Female; D005269:Femur / Q000033:anatomy & histology; D006801:Humans; D007719:Knee Joint / Q000033:anatomy & histology / Q000502:physiology; D008297:Male; D013977:Tibia / Q000033:anatomy & histology