title: Behind-remnant arthroscopic observation and scoring of femoral attachment of injured anterior cruciate ligament.
abstract: OBJECTIVE
  To describe the femoral anterior cruciate ligament (ACL) attachment based on the behind-remnant observation with a new scoring system and to investigate the characteristics of an ACL injured knee.
  
  
  METHODS
  One hundred and twenty-six ACL injured knees with four standardized arthroscopic photos and full evaluation under anaesthesia were included in the study. Sixty non-ACL injured knees were also evaluated as control. A scoring system for the femoral ACL attachment was set as follows based on behind-remnant findings; the direct insertion was divided into three portions as proximal, middle and distal. The fibrous extension from the articular surface (indirect insertion) and the severity of synovitis were also graded into 2, 1 and 0 points. The total score was 10 as full marks. The correlation between each score and total score, as well as age at surgery, gender, anterior laxity, pivot-shift test and meniscus injuries, was statistically evaluated with a significance of 0.05.
  
  
  RESULTS
  The femoral attachment score of the ACL injured knees was statistically different from that of the non-ACL injured knees. Anterior laxity was dependent only on the integrity of the proximal portion. Knee instability was significantly correlated with the status of the direct insertion. Medial and lateral meniscus injuries were correlated with the middle part and the distal part of the direct insertion, respectively. The direct insertion was less preserved in distal and articular sides.
  
  
  CONCLUSIONS
  Arthroscopic observation behind the remnant of the injured ACL showed clearer findings of the femoral attachment than that from the front. Behind-remnant observation greatly assists in the creation of a correct anatomical tunnel with the preserving remnant. The scoring system indicated several significant correlations between the score and preoperative patient status.
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Medical and Dental University Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. muneta.orj@tmd.ac.jp.|Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan. muneta.orj@tmd.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Muneta
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Medical and Dental University Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Koga
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Medical and Dental University Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
authors.forename: Tomomasa
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Medical and Dental University Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Horie
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Medical and Dental University Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Medical and Dental University Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Sekiya
mesh_terms: D000293:Adolescent; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy; D002358:Cartilage, Articular / Q000601:surgery; D005260:Female; D005269:Femur / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery; D012189:Retrospective Studies; D055815:Young Adult
keywords: Anterior cruciate ligament; Arthroscopic observation; Behind-remnant; Femoral attachment; Preoperative patient status; Scoring system