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      Three dimensional anatomy of the anterior cruciate ligament: a new approach in anatomical orthopedic studies and a literature review

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          Abstract

          Background

          The anterior cruciate ligament (ACL) is an important structure in the knee. The ACL does not heal following lesions, and surgical reconstruction is the standard treatment among athletes. Some steps of ACL reconstruction remain controversial. It is important to fully understand the anatomy of the ACL to accurately reproduce its anatomy during surgical reconstructions. The purpose of this study was to evaluate the use of anaglyphic images that produce 3D images to better visualize the anatomy of the ACL, and to highlight the anatomical features of this ligament as reported in the literature.

          Methods

          We included ten knees in this study. After dissection of the knee structures, pictures were acquired using a camera with Nikon D40, AF-S Nikkor 18–55 mm (1:3.5–5.6 G2 ED), and Micro Nikkor 105 mm (1:2.8) lenses. The pair of images was processed using Callipyan 3D Anabuilder software, which transforms the two images into one anaglyphic image.

          Results

          During the dissection of the knees, nine pictures were acquired and transformed into anaglyphic images.

          Conclusion

          This study, demonstrated that the use of 3D images is a useful tool that can improve the knowledge of the anatomy of the knee, while also facilitating knee reconstruction surgery.

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          Most cited references21

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          Anatomy of the anterior cruciate ligament.

          The anterior cruciate ligament (ACL) is a band of dense connective tissue which courses from the femur to the tibia. The ACL is a key structure in the knee joint, as it resists anterior tibial translation and rotational loads. When the knee is extended, the ACL has a mean length of 32 mm and a width of 7-12 mm. There are two components of the ACL, the anteromedial bundle (AMB) and the posterolateral bundle (PLB). They are not isometric with the main change being lengthening of the AMB and shortening of the PLB during flexion. The ACL has a microstructure of collagen bundles of multiple types (mostly type I) and a matrix made of a network of proteins, glycoproteins, elastic systems, and glycosaminoglycans with multiple functional interactions. The complex ultrastructural organization and abundant elastic system of the ACL allow it to withstand multiaxial stresses and varying tensile strains. The ACL is innervated by posterior articular branches of the tibial nerve and is vascularized by branches of the middle genicular artery.
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            Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study.

            Anatomic tunnel placement is critical to the success of anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to determine qualitatively and quantitatively the osseous landmarks of femoral attachment of the ACL. The femoral attachment of the ACL was studied histologically in seven human fetuses, arthroscopically in 60 patients who underwent ACL surgery, and grossly in 16 cadaveric knees. Three-dimensional laser digitizer pictures of the cadaveric specimens were taken to quantify length, area, and angulations of the femoral attachment of the ACL. Two different osseous landmarks were detected. An osseous ridge that runs from proximal to distal ends was present in all the arthroscopic patients and cadaveric knees. It was named "lateral intercondylar ridge." Another osseous landmark between the femoral attachment of the anteromedial (AM) and posterolateral (PL) bundles running from anterior to posterior was observed in 6 out of 7 fetuses, 49 out of 60 arthroscopic patients, and 13 out of 16 cadaveric knees. It was named "lateral bifurcate ridge." A change of slope between the femoral attachment of the AM and PL bundles was observed in all specimens studied. The femoral attachment of the AM bundle formed an angle with the PL bundle of 27.6 degrees +/- 8.8 degrees and a radius of curvature of 25.7 +/- 12 mm. The area of the entire ACL footprint, AM, and PL bundle was 196.8 +/- 23.1 mm(2), 120 +/- 19 mm(2), and 76.8 +/- 15 mm(2), respectively. The ACL femoral attachment has a unique topography with a constant presence of the lateral intercondylar ridge and often an osseous ridge between AM and PL femoral attachment, the lateral bifurcate ridge. These findings may assist surgeons to perform ACL surgery in a more anatomic fashion.
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              Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries.

              This work studied the fibre bundle anatomy of the anterior cruciate ligament. Three functional bundles--anteromedial, intermediate, and posterolateral--were identified in cadaver knees. Their contributions to resisting anterior subluxation in flexion and extension were found by repeated tests after sequential bundle transection. Changes of length in flexion and extension and in tibial rotation were measured. None of the fibres were isometric. The posterolateral bundle was stretched in extension and the anteromedial in flexion, which correlated with increased contributions to knee stability and the likelihood of partial ruptures in these positions. Tibial rotation had no significant effect. The fibre length changes suggested that the 'isometric point' aimed at by some ligament replacements lay anterior and superior to the femoral origin of the intermediate fibre bundle and towards the roof of the intercondylar notch.
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                Author and article information

                Journal
                Open Access J Sports Med
                Open Access J Sports Med
                Open Access Journal of Sports Medicine
                Open Access Journal of Sports Medicine
                Dove Medical Press
                1179-1543
                2012
                12 November 2012
                : 3
                : 183-188
                Affiliations
                [1 ]Centro de Traumatologia do Esporte (CETE), Departamento de Ortopedia e Traumatologia da Universidade Federal de São Paulo SP, Brazil (DOT-UNIFESP/EPM)
                [2 ]Departamento de Ortopedia e Traumatologia Faculdade de Ciências Médicas da Santa Casa de São Paulo SP, Brazil
                [3 ]Departamento de Ortopedia e Traumatologia da Faculdade de Medicina de São José do Rio Preto SP, Brazil
                [4 ]Laboratory of Arthroscopic and Surgical Anatomy, Department of Pathology and Experimental Therapeutics, University of Barcelona, Spain
                [5 ]Department of Orthopedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
                Author notes
                Correspondence: Gustavo Arliani, Rua Borges Lagoa, 783–5° andar, Vila Clementino, São Paulo SP, Brazil 04038-032. Tel +11 55 5571 6621 Email ggarliani@ 123456hotmail.com
                Article
                oajsm-3-183
                10.2147/OAJSM.S37203
                3781913
                24198601
                53e7668d-50a4-409e-ad1f-a6f2de1f8ecd
                © 2012 Arliani et al, publisher and licensee Dove Medical Press Ltd

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                History
                Categories
                Original Research

                anatomy education,photography methods,education,medical methods,eyeglasses,anaglyphic

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