title: Ribbon like appearance of the midsubstance fibres of the anterior cruciate ligament close to its femoral insertion site: a cadaveric study including 111 knees.
abstract: OBJECTIVE
  Recently, the configuration of the anterior cruciate ligament (ACL) from its direct femoral insertion to midsubstance was found to be flat. This might have an important impact for anatomical ACL reconstruction. The purpose of this anatomical study was to evaluate the macroscopic appearance of the ACL from femoral to midsubstance.
  
  
  METHODS
  The ACL was dissected in 111 human fresh frozen cadaver knees from its femoral insertion to midsubstance, and the shape was described. The anatomical findings were documented on digital photographs and on video. Thirty knees were sent for computed tomography (CT), magnetic resonance imaging (MRI) and histology of the femoral ACL insertion.
  
  
  RESULTS
  Two millimetres from its direct femoral insertion, the ACL fibres formed a flat ribbon in all dissected knees without a clear separation between AM and PL bundles. The ribbon was in exact continuity of the posterior femoral cortex. The width of the ribbon was between 11.43 and 16.18 mm and the thickness of the ACL was only 2.54-3.38 mm. 3D CT, MRI and the histological examination confirmed above findings.
  
  
  CONCLUSIONS
  This is a detailed anatomical study describing the ribbon-like structure of the ACL from its femoral insertion to midsubstance. A key point was to carefully remove the surface fibrous membrane of the ACL. A total of 2-3 mm from its bony femoral insertion, the ACL formed a flat ribbon without a clear separation between AM and PL bundles. The ribbon was in exact continuity of the posterior femoral cortex. The findings of a flat ligament may change the future approach to femoral ACL footprint and midsubstance ACL reconstruction and to graft selection.
authors: Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757, Warsaw, Poland. robert.smigielski@carolina.pl.
authors: Robert
authors: R
authors: Śmigielski
authors: Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757, Warsaw, Poland.
authors: Urszula
authors: U
authors: Zdanowicz
authors: Orthopaedic and Sports Traumatology Department, Carolina Medical Center, Pory 78, 02-757, Warsaw, Poland.
authors: Michał
authors: M
authors: Drwięga
authors: Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Chalbinskiego 5, 02-004, Warsaw, Poland.
authors: Bogdan
authors: B
authors: Ciszek
authors: Department of Radiology, Carolina Medical Center, Pory 78, 02-757, Warsaw, Poland.
authors: Beata
authors: B
authors: Ciszkowska-Łysoń
authors: Institute for Anatomy and Cell Biology, INF, Ruprecht-Karls University Heidelberg, Heidelberg, Germany. rainer.siebold@atos.de.|HKF: Center for Spezialised Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany. rainer.siebold@atos.de.
authors: Rainer
authors: R
authors: Siebold
mesh_terms: D000328:Adult; D000368:Aged; D016118:Anterior Cruciate Ligament / Q000033:anatomy & histology*; D002102:Cadaver; D005260:Female; D005269:Femur / Q000033:anatomy & histology*; D006801:Humans; D007717:Knee / Q000033:anatomy & histology*; D008297:Male; D008875:Middle Aged
keywords: ACL; Anatomy; Anterior cruciate ligament; Femoral insertion; Intraligamentous; Midsubstance; Ribbon