No Correlation of Height or Gender with Anterior Cruciate Ligament Footprint Size

ABSTRACT

Recently, there has been much interest in anatomic double-bundle reconstruction of the anterior cruciate ligament (ACL). Double-bundle reconstruction of the ACL requires adequate footprint size to place two femoral tunnels. The purpose of this study was to determine if there is a correlation between lateral intercondylar ridge length and gender and/or height. We measured the femoral attachment of the ACL to determine if patient sex and/or height could be used to predict ACL femoral footprint size. We measured the length of the lateral intercondylar ridge in 65 skeletally mature human femora. Gender and height was recorded for each individual. We used bivariate regression analysis to determine correlations between both height and gender and the length of the lateral intercondylar ridge. The principal findings of our study demonstrate that there is no correlation between ACL femoral footprint size and gender or footprint size and height. Our study demonstrates that patient height and gender cannot be used for preoperative planning when deciding whether a given patient has adequate footprint size to support double-bundle reconstruction of the ACL.

KEYWORDS

Lateral intercondylar ridge - resident's ridge - anterior cruciate ligament - double bundle - femoral tunnel

REFERENCES

• 1 Pombo M W, Shen W, Fu F H. Anatomic double-bundle anterior cruciate ligament reconstruction: where are we today?.  Arthroscopy. 2008;  24 1168-1177
• 2 Girgis F G, Marshall J L, Monajem A. The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis.  Clin Orthop Relat Res. 1975;  (106) 216-231
• 3 Mochizuki T, Muneta T, Nagase T, Shirasawa S, Akita K I, Sekiya I. Cadaveric knee observation study for describing anatomic femoral tunnel placement for two-bundle anterior cruciate ligament reconstruction.  Arthroscopy. 2006;  22 356-361
• 4 Norwood Jr L A, Cross M J. The intercondylar shelf and the anterior cruciate ligament.  Am J Sports Med. 1977;  5 171-176
• 5 Mae T, Shino K, Miyama T et al.. Single- versus two-femoral socket anterior cruciate ligament reconstruction technique: Biomechanical analysis using a robotic simulator.  Arthroscopy. 2001;  17 708-716
• 6 Yagi M, Wong E K, Kanamori A, Debski R E, Fu F H, Woo S L. Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction.  Am J Sports Med. 2002;  30 660-666
• 7 Zantop T, Wellmann M, Fu F H, Petersen W. Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: Anatomic and radiographic findings.  Am J Sports Med. 2008;  36 65-72
• 8 Edwards T B, Guanche C A, Petrie S G, Thomas K A. In vitro comparison of elongation of the anterior cruciate ligament and single- and dual-tunnel anterior cruciate ligament reconstructions.  Orthopedics. 1999;  22 577-584
• 9 Meredick R B, Vance K J, Appleby D, Lubowitz J H. Outcome of single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: A meta-analysis.  Am J Sports Med. 2008;  36 1414-1421
• 10 Siebold R, Dehler C, Ellert T. Prospective randomized comparison of double-bundle versus single-bundle anterior cruciate ligament reconstruction.  Arthroscopy. 2008;  24 137-145
• 11 Muneta T, Koga H, Mochizuki T et al.. A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques.  Arthroscopy. 2007;  23 618-628
• 12 Purnell M L, Larson A I, Clancy W. Anterior cruciate ligament insertions on the tibia and femur and their relationships to critical bony landmarks using high-resolution volume-rendering computed tomography.  Am J Sports Med. 2008;  36 2083-2090
• 13 Ferretti M, Ekdahl M, Shen W, Fu F H. Osseous landmarks of the femoral attachment of the anterior cruciate ligament: An anatomic study.  Arthroscopy. 2007;  23 1218-1225
• 14 Colombet P, Robinson J, Christel P et al.. Morphology of anterior cruciate ligament attachments for anatomic reconstruction: A cadaveric dissection and radiographic study.  Arthroscopy. 2006;  22 984-992
• 15 Takahashi M, Doi M, Abe M, Suzuki D, Nagano A. Anatomical study of the femoral and tibial insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament.  Am J Sports Med. 2006;  34 787-792
• 16 Muneta T, Takakuda K, Yamamoto H. Intercondylar notch width and its relation to the configuration and cross-sectional area of the anterior cruciate ligament. A cadaveric knee study.  Am J Sports Med. 1997;  25 69-72
• 17 Harner C D, Baek G H, Vogrin T M, Carlin G J, Kashiwaguchi S, Woo S L. Quantitative analysis of human cruciate ligament insertions.  Arthroscopy. 1999;  15 741-749
• 18 Farrow L D, Chen M R, Cooperman D R, Victoroff B N, Goodfellow D B. Morphology of the femoral intercondylar notch.  J Bone Joint Surg Am. 2007;  89 2150-2155
• 19 Liu R W, Farrow L D, Messerschmitt P J, Gilmore A, Goodfellow D B, Cooperman D R. An anatomical study of the pediatric intercondylar notch.  J Pediatr Orthop. 2008;  28 177-183
• 20 Chandrashekar N, Slauterbeck J, Hashemi J. Sex-based differences in the anthropometric characteristics of the anterior cruciate ligament and its relation to intercondylar notch geometry: A cadaveric study.  Am J Sports Med. 2005;  33 1492-1498
• 21 Tillman M D, Smith K R, Bauer J A, Cauraugh J H, Falsetti A B, Pattishall J L. Differences in three intercondylar notch geometry indices between males and females: A cadaver study.  Knee. 2002;  9 41-46
• 22 Charlton W P, St John T A, Ciccotti M G, Harrison N, Schweitzer M. Differences in femoral notch anatomy between men and women: A magnetic resonance imaging study.  Am J Sports Med. 2002;  30 329-333
• 23 Hutchinson M R, Ash S A. Resident's ridge: Assessing the cortical thickness of the lateral wall and roof of the intercondylar notch.  Arthroscopy. 2003;  19 931-935
• 24 Farrow L D, Gillespie R J, Victoroff B N, Cooperman D R. Radiographic location of the lateral intercondylar ridge: Its relationship to Blumensaat's line.  Am J Sports Med. 2008;  36 2002-2006