Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Arthroscopy. 2010 Sep;26(9 Suppl):S13-20. doi: 10.1016/j.arthro.2010.01.023. Epub 2010 Jul 29.
The purpose of this study was to histologically identify the direct and indirect insertion of the femoral anterior cruciate ligament (ACL) insertion. Furthermore, we quantitatively measured the direct femoral insertion area by use of the 3-dimensional (3D) volume-rendered (VR) computed tomography (CT) model.
By use of 8 intact cadaveric knees, the lateral femoral condyle including the ACL attachment was sectioned for histologic examination in 3 oblique-axial planes parallel to the roof of the intercondylar notch and in the sagittal planes. Before sectioning, these knees had been subjected to CT to obtain 3D VR images of the femur. Once the direct insertion of the ACL was identified on each histologic section, the corresponding image was superimposed on the corresponding CT image.
The direct ACL insertion, in which dense collagen fibers were connected to the bone by the fibrocartilaginous layer, was microscopically identified at the region between the posteromedial articular cartilage margin of the lateral femoral condyle and the linear bony ridge 7 to 10 mm anterior to the articular cartilage margin. Meticulous comparison of histologic analysis and the 3D VR CT model showed that the ACL direct insertion coincided with a crescent-shaped hollow just behind the linear bony ridge. The direct insertion measured 17.4 +/- 0.9 mm (mean +/- SD) in length, 8.0 +/- 0.5 mm in width, and 128.3 +/- 10.5 mm(2) in area.
The direct insertion of the ACL is located in the depression between the resident's ridge and the articular cartilage margin on the lateral femoral condyle. It measured 17.4 +/- 0.9 mm in length, 8.0 +/- 0.5 mm in width, and 128.3 +/- 10.5 mm(2) in area.
Delineation of the ACL femoral direct insertion by 3D VR CT could be a useful tool for planning of accurate femoral tunnel positioning in anatomic ACL reconstruction.
本研究旨在通过组织学方法确定前交叉韧带（ACL）股骨止点的直接和间接附着点，并利用三维容积再现（3D VR）CT 模型对直接附着区进行定量测量。
对 8 个完整的尸体膝关节标本进行研究，在平行于髁间窝顶的 3 个斜矢状面和矢状面将包含 ACL 附着处的外侧股骨髁进行分段，以进行组织学检查。在分段之前，这些膝关节已经接受 CT 检查，以获得股骨的 3D VR 图像。一旦在每个组织学切片上确定 ACL 的直接附着点，就将相应的图像叠加到相应的 CT 图像上。
在外侧股骨髁后关节软骨缘和软骨缘前 7 至 10mm 的线性骨嵴之间的区域，显微镜下观察到 ACL 的直接附着处，此处有致密的胶原纤维通过纤维软骨层与骨相连。对组织学分析和 3D VR CT 模型进行仔细比较后发现，ACL 的直接附着点与线性骨嵴后面的新月形凹陷相对应。直接附着点的长度为 17.4 ± 0.9mm（平均值 ± 标准差），宽度为 8.0 ± 0.5mm，面积为 128.3 ± 10.5mm²。
ACL 的直接附着点位于外侧股骨髁的居民嵴和关节软骨缘之间的凹陷处。其长度为 17.4 ± 0.9mm，宽度为 8.0 ± 0.5mm，面积为 128.3 ± 10.5mm²。
3D VR CT 可用于对 ACL 股骨直接附着点进行描绘，这可能是在解剖学 ACL 重建中进行准确股骨隧道定位的有用工具。
