Lin Jinrong, Zhang Shurong, Xin Enhui, Liang Meng, Yang Liqin, Chen Jiwu
Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China.
Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Jing'an District, Shanghai, 200040, People's Republic of China.
Knee Surg Sports Traumatol Arthrosc. 2023 Dec;31(12):5514-5523. doi: 10.1007/s00167-023-07606-6. Epub 2023 Oct 12.
This study aimed to evaluate the morphology of the anterior cruciate ligament (ACL) femoral footprint with three-dimensional magnetic resonance imaging (3D MRI) in healthy knees.
Fifty subjects with healthy knees were recruited, utilising 3D-SPACE sequences for ACL evaluation. The ACL was manually segmented, and the shape, size and location of the ACL femoral footprint were evaluated on a reformatted oblique-sagittal plane, which aligned closely with the ACL attachment. Statistical analysis included one-way ANOVA for continuous variables and Fisher's exact test for categorical variables, with a P value < 0.05 considered significant.
Three types of ACL femoral footprint shape were identified, namely, oblong-ovate (OO) in 33 knees (66%), triangular (Tr) in 12 knees (24%) and two-tears (TT) in 5 knees (10%), with the mean areas being 58, 47 and 68 mm, respectively. Within group TT, regions with similar sizes but different locations were identified: high tear (TT-H) and low tear (TT-L). Notably, group OO demonstrated a larger notch height index, whilst group TT was characterised by a larger α angle and lateral femoral condyle index. A noticeable variation was observed in the location of the femoral footprint centre across groups, with group TT-L and group Tr showing a more distal position relative to the apex of the deep cartilage. According to the Bernard and Hertel (BH) grid, the ACL femoral footprint centres in group TT-L exhibited a shallower and higher position than other groups. Furthermore, compared to group OO and TT-H, group Tr showed a significantly higher position according to the BH grid.
In this study, the morphology of the ACL femoral footprint in healthy young adults was accurately evaluated using 3D MRI, revealing three distinct shapes: OO, Tr and TT. The different ACL femoral footprint types showed similar areas but markedly different locations. These findings emphasise the necessity of considering both the shape and precise location of the ACL femoral footprint during clinical assessments, which might help surgeons enhance patient-specific surgical plans before ACL reconstruction.
IV.
本研究旨在利用三维磁共振成像（3D MRI）评估健康膝关节前交叉韧带（ACL）股骨足迹的形态。
招募50名健康膝关节受试者，采用3D-SPACE序列评估ACL。手动分割ACL，并在与ACL附着紧密对齐的重组斜矢状面上评估ACL股骨足迹的形状、大小和位置。统计分析包括对连续变量进行单因素方差分析，对分类变量进行Fisher精确检验，P值<0.05被认为具有统计学意义。
确定了三种类型的ACL股骨足迹形状，即33例膝关节（66%）为长椭圆形（OO），12例膝关节（24%）为三角形（Tr），5例膝关节（10%）为双泪形（TT），平均面积分别为58、47和68平方毫米。在TT组内，确定了大小相似但位置不同的区域：高撕裂（TT-H）和低撕裂（TT-L）。值得注意的是，OO组显示出更大的切迹高度指数，而TT组的特征是更大的α角和外侧髁指数。各组股骨足迹中心的位置存在明显差异，TT-L组和Tr组相对于深层软骨顶点显示出更靠远端的位置。根据伯纳德和赫特尔（BH）网格，TT-L组的ACL股骨足迹中心比其他组显示出更浅和更高的位置。此外，与OO组和TT-H组相比，Tr组根据BH网格显示出明显更高的位置。
在本研究中，使用3D MRI准确评估了健康年轻成年人ACL股骨足迹的形态，揭示了三种不同的形状：OO、Tr和TT。不同类型的ACL股骨足迹显示出相似的面积，但位置明显不同。这些发现强调了在临床评估中考虑ACL股骨足迹的形状和精确位置的必要性，这可能有助于外科医生在ACL重建术前制定更个性化的手术方案。
IV级。
