Iriuchishima Takanori, Goto Bunsei
Department of Orthopaedic Surgery, Kamimoku Spa Hospital, Minakami, Japan.
Department of Functional Morphology, Nihon University School of Medicine, Tokyo, Japan.
Indian J Orthop. 2022 Jul 18;56(9):1525-1532. doi: 10.1007/s43465-022-00695-4. eCollection 2022 Sep.
The purpose of this systematic review was to review the anatomical reports concerning the anterior cruciate ligament (ACL) focusing on the mid-substance insertion and fan-like extension fibers, or direct and indirect insertions.
Following the PRISMA, data collection was performed. PubMed, Web of Science, and the Cochran library were searched with the terms "anterior cruciate ligament reconstruction", "anatomy", and "cadaver". Studies were included when anatomical dissection of the ACL with cadavers was performed. Biomechanical studies without a detailed description of the anatomical dissection, reviews, and studies not including pictures of the anatomical specimens were excluded from this study. In the full article review, documentation of the mid-substance insertion and fan-like extension fibers, or direct and indirect insertions in the ACL morphology was evaluated in detail.
Fifty-seven studies were included for detailed evaluation. In 2006, Mochizuki et al. reported a macroscopic differentiation between the mid-substance insertion and fan-like extension fibers in the ACL footprint. In 2010, Iwahashi et al. detected the existence of direct and indirect insertions within the femoral ACL footprint, microscopically. Following Mochizuki's report, anatomical evaluation of the mid-substance insertion and fan-like extension fibers, or direct and indirect insertions was reported in 16 of 51 ACL anatomical studies. In studies focusing on the morphology of the ACL, 16 of 28 studies addressed this subject. In these studies, the mid-substance insertion and fan-like extension fibers were differentiated macroscopically, and the direct and indirect insertions were differentiated microscopically within the ACL footprint. Fan-like extension fibers or indirect insertion was reported to surround the mid-substance insertion or direct insertion within the femoral ACL footprint.
The results of this systematic review showed that, the existence of the mid-substance insertion and fan-like extension fibers, or direct and indirect insertions in ACL morphology is being recognized more widely. These structures should be taken into consideration when surgeons perform ACL surgery.
III. Systematic review of Level-III studies.
The online version contains supplementary material available at 10.1007/s43465-022-00695-4.
本系统评价旨在回顾有关前交叉韧带（ACL）的解剖学报告，重点关注韧带中部插入点和扇形延伸纤维，或直接和间接插入情况。
按照PRISMA进行数据收集。在PubMed、科学网和Cochrane图书馆中检索“前交叉韧带重建”“解剖学”和“尸体”等关键词。纳入对尸体进行ACL解剖的研究。未详细描述解剖过程的生物力学研究、综述以及未包含解剖标本图片的研究被排除在本研究之外。在全文综述中，详细评估了韧带中部插入点和扇形延伸纤维，或ACL形态中直接和间接插入情况的记录。
57项研究纳入详细评估。2006年，望月等人报告了ACL足迹中韧带中部插入点和扇形延伸纤维的宏观差异。2010年，岩桥等人在显微镜下检测到股骨ACL足迹内直接和间接插入的存在。继望月的报告之后，51项ACL解剖学研究中有16项报告了对韧带中部插入点和扇形延伸纤维，或直接和间接插入的解剖学评估。在关注ACL形态的研究中，28项研究中有16项涉及该主题。在这些研究中，韧带中部插入点和扇形延伸纤维在宏观上有差异，而直接和间接插入在ACL足迹内通过显微镜进行区分。据报告，扇形延伸纤维或间接插入围绕着股骨ACL足迹内的韧带中部插入点或直接插入点。
本系统评价结果表明，ACL形态中韧带中部插入点和扇形延伸纤维，或直接和间接插入的存在正得到更广泛的认可。外科医生进行ACL手术时应考虑这些结构。
III。III级研究的系统评价。
在线版本包含可在10.1007/s43465-022-00695-4获取的补充材料。
