Janovsky César, Kaleka Camila Cohen, Alves Maria Teresa Seixas, Ferretti Mario, Cohen Moises
Sports Orthopedic Trauma Center, Orthopedic Department, Federal University of São Paulo, UNIFESP, São Paulo, Brazil.
Hospital Israelita Albert Einstein, São Paulo, Brazil.
Orthop J Sports Med. 2016 Nov 8;4(11):2325967116671300. doi: 10.1177/2325967116671300. eCollection 2016 Nov.
Although numerous anatomic studies about the anterior cruciate ligament (ACL) structure and attachments have been performed, these studies have not reached consensus on the ACL footprint.
To investigate the existing controversy regarding the morphology of the tibial ACL insertion (footprint) and confirm histologically that the tibial ACL footprint is not completely filled with ligament tissue.
Descriptive laboratory study.
The tibial ACL footprint was dissected from 20 different fresh-frozen cadaveric knees (all males; mean age, 68.8 ± 5.4 years [range, 55-80 years]; mean weight, 78 ± 6.6 kg [range, 45-93 kg]). Two knees, 1 with severe osteoarthritis and 1 with previous knee surgery, were excluded. The tibial ACL insertion was observed, and this area was longitudinally divided into 4 parallel slices (0%-25%, 25-50%, 50%-75%, and 75%-100%), embedded in paraffin wax, and stained with hematoxylin-eosin, alcian blue, and picrosirius-polarization. The specimens were measured using a microscope to determine the distances from the anterior to the posterior border of the ACL ligament tibial insertion and the distance from the posterior border to the end of the ligament fibers of the ACL ligament tibial insertions.
The 18 evaluated knee specimens confirmed the finding of a C-shaped tibial insertion of the ACL. The measurements showed that the ligament (vertical parallel collagen fibers) occupied only 30.8% of the complete insertion. The remaining area was filled with synovial tissue, demonstrating histologically the "C" shape.
This study confirms macroscopically the C-shaped tibial insertion of the ACL and shows histologically that synovial tissue is an indirect insertion filling the major part of the footprint.
This anatomic study suggests a different shape of the ACL tibial footprint, which may be useful for new perspectives regarding ACL reconstruction surgery research.
尽管已经对前交叉韧带（ACL）的结构和附着点进行了大量解剖学研究，但这些研究在ACL足迹方面尚未达成共识。
探讨关于胫骨ACL插入部（足迹）形态的现有争议，并通过组织学证实胫骨ACL足迹并未完全被韧带组织填充。
描述性实验室研究。
从20个不同的新鲜冷冻尸体膝关节（均为男性；平均年龄68.8±5.4岁[范围55 - 80岁]；平均体重78±6.6千克[范围45 - 93千克]）上解剖出胫骨ACL足迹。排除2个膝关节，1个患有严重骨关节炎，1个曾接受过膝关节手术。观察胫骨ACL插入部，并将该区域纵向分成4个平行切片（0% - 25%、25% - 50%、50% - 75%和75% - 100%），用石蜡包埋，并用苏木精 - 伊红、阿尔辛蓝和天狼星偏振染色。使用显微镜测量标本，以确定ACL韧带胫骨插入部从前边界到后边界的距离以及从后边界到ACL韧带胫骨插入部韧带纤维末端的距离。
18个评估的膝关节标本证实了ACL胫骨插入部呈C形的发现。测量结果显示，韧带（垂直平行胶原纤维）仅占据整个插入部的30.8%。其余区域充满滑膜组织，从组织学上显示出“C”形。
本研究从宏观上证实了ACL胫骨插入部呈C形，并从组织学上表明滑膜组织是填充足迹主要部分的间接插入物。
这项解剖学研究提示了ACL胫骨足迹的不同形状，这可能为ACL重建手术研究提供新的视角。
