Abstract
The femoral footprint of the anterior cruciate ligament (ACL) is a much-studied anatomic structure, predominantly due to its importance during ACL reconstruction surgery. A new technique utilising high-resolution micro-computed tomography (micro-CT) is described, allowing detailed three-dimensional (3D) quantitative analysis of this structure. Seven cadaveric knees were scanned using micro-CT, yielding 3D data with a reconstructed voxel size of 60 μm. A novel method of 3D surface extraction was developed and validated, facilitating both qualitative observation of surface details and quantitative topographic assessment using colour-coded relief maps. Images were displayed on an immersive 3D visualisation wall, and ten experienced ACL clinicians were surveyed as to the presence and morphology of osseous landmarks, providing qualitative assessment of whether such features can be reliably identified for navigation during surgery. Both quantitative analysis and qualitative assessment of the footprints in this study showed significant variability in the presence and morphology of osseous landmarks, with the lateral intercondylar ridge being objectively present in four out of seven relief maps, although reportedly seen in six out of seven cases in the qualitative study, suggesting an element of subjectivity and interpretation. This is the first study to utilise micro-CT in the study of ACL anatomy.
Similar content being viewed by others
Change history
13 November 2017
An author has corrected their first name and updated their email address - see the affiliation section below. Daniel G. Norman should now be Danielle G. Norman as shown in the authorgroup section above.
Abbreviations
- ACL:
-
Anterior cruciate ligament
- CT:
-
Computed tomography
- ROI:
-
Region of interest
- CAD:
-
Computer aided design
- STL:
-
Stereolithography file
References
Abulrub AG, Attridge A, Williams MA (2011) Virtual reality in engineering education: the future of creative learning. iJET 60(4):4–11
Baudoin A, Skalli W, de Guise JA, Mitton D (2008) Parametric subject-specific model for in vivo 3D reconstruction using bi-planar X-rays: application to the upper femoral extremity. Med Biol Eng Comput 46(8):799–805
Bernard M, Hertel P, Hornung H, Cier-pinski T (1997) Femoral insertion of the ACL. Radiographic quadrant method. Am J Knee Surg 10(1):14–21
Besl PJ, McKay ND (1992) A method for registration of 3-D shapes. IEEE Trans Pattern Anal Mach Intell 14(2):239–256
Bird JH, Carmont MR, Dhillon M, Smith N, Brown C, Thompson P, Spalding T (2011) Validation of a new technique to determine midbundle femoral tunnel position in anterior cruciate ligament reconstruction using 3-dimensional computed tomography analysis. Arthroscopy 27(9):1259–1267
Bottino A, Nuij W, van Overveld K (1996) How to shrinkwrap through a critical point: an algorithm for the adaptive triangulation of iso-surfaces with arbitrary topology. Proc Implic Surf 96:53–72
Brown LG (1992) A survey of image registration techniques. ACM Comput Surv (CSUR) 24(4):325–376
Campbell RJ, Flynn PJ (2001) A survey of free-form object representation and recognition techniques. Comput Vis Image Underst 81(2):166–210
Cohen JD (1998) Appearance-preserving simplification of polygonal models. Ph.D. Dissertation. University of North Carolina at Chapel Hill
Colombet P, Robinson J, Christel P (2006) Morphology of anterior cruciate ligament attachments for anatomic reconstruction: a cadaveric dissection and radiographic study. Arthroscopy 22:984–992
Duthon VB, Barea C, Abrassart S, Fasel JH, Fritschy D, Menetrey J (2006) Anatomy of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 14:204–213
Edwards A, Bull AM, Amis AA (2008) The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament. Part 2: femoral attachment. Knee Surg Sports Traumatol Arthrosc 16:29–36
Farrow LD, Chen MR, Cooperman DR, Victoroff BN, Goodfellow DB (2007) Morphology of the femoral intercondylar notch. J Bone Joint Surg 89(10):2150–2155
Feldkamp LA, Davis LC, Kress JW (1984) Practical cone-beam algorithm. JOSA A 1(6):612–619
Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23(11):1218–1225
Fleiss JL (1981) Statistical methods for raters and proportions, 2nd edn. Wiley, New York
Fleiss JL (1997) Measuring nominal scale agreement among many raters. Psychol Bull 76(5):378–382
Frey WH, Field DA (1991) Mesh relaxation: a new technique for improving triangulations. Int J Numer Meth Eng 31(6):1121–1133
Fu FH, Karlsson J (2010) A long journey to be anatomic. Knee Surg Sports Traumatol Arthrosc 18(9):1151–1153
Girgis FG, Marshall JL, JEM AAM (1975) The cruciate ligaments of the knee joint: anatomical, functional and experimental analysis. Clin Orthop Relat Res 106:216–231
Giron F, Cuomo P, Aglietti P, Bull AM, Amis AA (2006) Femoral attachment of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 14:250–256
Hayes AF, Krippendorff K (2007) Answering the call for a standard reliability measure for coding data. Commun Methods Measures 1:77–89
Huchinson MR, Ash SA (2003) Resident’s ridge: assessing the cortical thickness of the lateral wall and roof of the intercondylar notch. Arthroscopy 19(9):931–935
Illingworth KD, Hensler D, Working ZM, Macalena AJ, Tashman S, Fu FH (2011) A simple evaluation of anterior cruciate ligament femoral tunnel position: the inclination angle and femoral tunnel angle. Am J Sports Med 39(12):2611–2618
Jabara MR, Clancy WG Jr (2005) Anatomic arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon–bone autograft. Tech Orthop 20(4):405–413
Klein R, Liebich G, Straßer W (1996). Mesh reduction with error control. In: Visualization ‘96. Proceedings: 311–318. IEEE
Kopf S, Musahl V, Tashman S, Szczodry M, Shen W, Fu F (2009) A systematic review of the femoral origin and tibial insertion morphology of the ACL. Knee Surg Sports Traumatol Arthrosc 17:213–219
Krippendorff K (1980) Content analysis: an introduction to its methodology. Sage, Beverly Hills, CA
Kruth JP, Bartscher M, Carmignato S, Schmitt R, De Chiffre L, Weckenmann A (2011) Computed tomography for dimensional metrology. CIRP Ann Manufac Technol 60(2):821–842
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Likert R (1932) A technique for the measurement of attitudes. Archives of Psychology 140:1–55
Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL (2002) Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o’clock and 10 o’clock femoral tunnel placement. 2002 Richard O’Connor Award paper. Arthroscopy 19:297–304
Maire E, Withers PJ (2014) Quantitative X-ray tomography. Int Mater Rev 59(1):1–43
Odensten M, Gillquist J (1985) Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg 67(2):257–262
Pietrini SD, Ziegler CG, Anderson CJ et al (2011) Radiographic landmarks for tunnel positioning in double-bundle ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 19:792–800
Purnell ML, Larson AI, Clancy W (2008) Anterior cruciate ligament insertions on the tibia and femur and their relationships to critical bony landmarks using high-resolution volume-rendering computed tomography. Am J Sports Med 36(11):2083–2090
Randolph JJ (2005) Free-marginal multirater Kappa: an alternative to fleiss’ fixed-marginal multirater Kappa. Paper presented at: The Joensuu University Learning and Instruction Symposium October 14th, 2005; Joensuu, Finland
Relvas C, Ramos A, Completo A, Simões JA (2011) Accuracy control of complex surfaces in reverse engineering. Int J Precis Eng Manuf 12(6):1035–1042
Sandoz B, Badina A, Laporte S, Lambot K, Mitton D, Skalli W (2013) Quantitative geometric analysis of rib, costal cartilage and sternum from childhood to teenagehood. Med Biol Eng Comput 51(9):971–979
Sastre S, Popescu D, Núñez M, Pomes J, Tomas X, Peidro L (2010) Double-bundle versus single-bundle ACL reconstruction using the horizontal femoral position: a prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 18(1):32–36
Sim J, Wright CC (2005) The Kappa statistics in reliability studies: use, interpretation, and sample size requirements. Phys Ther 85:257–269
Steiner M (2009) Anatomic single-bundle ACL reconstruction. Sports Med Arthrosc Rev 17(4):247–251
Suomalainen P, Järvelä T, Paakkala A, Kannus P, Järvinen M (2012) Double-bundle versus single-bundle anterior cruciate ligament reconstruction A prospective randomized study with 5-year results. Am J Sports Med 40(7):1511–1518
Takahashi M, Doi M, Abe M, Suzuki D, Nagano A (2006) Anatomical study of the femoral and tibial insertions of the anteromedial and posterolateral bundles of human anterior cruciate ligament. Am J Sports Med 34(5):787–792
van Eck CF (2010) Does the lateral intercondylar ridge disappear in ACL deficient patients? Knee Surg Sports Traumatol Arthrosc 18:1184–1188
van Eck C, Samuelsson K, Vyas S, Dijk N, Karlsson J, Fu F (2011) Systematic review on cadaveric studies of anatomic anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 19(suppl 1):101–108
van Overveld C, Wyvill B (1993) Shrinkwrap: an adaptive algorithm for polygonizing an implicit surface. The University of Calgary, Department of computer science, Research Report No. 93/514/19, March 1993
Ziegler CG, Pietrini SD, Westerhaus BD et al (2011) Arthroscopically pertinent landmarks for tunnel positioning in single-bundle and double-bundle anterior cruciate ligament reconstructions. Am J Sports Med 39(4):743–752
Acknowledgments
The authors wish to acknowledge Smith and Nephew Endoscopy for their funding support.
Author information
Authors and Affiliations
Corresponding author
Additional information
A correction to this article is available online at https://doi.org/10.1007/s11517-017-1753-4.
Rights and permissions
About this article
Cite this article
Norman, D.G., Getgood, A., Thornby, J. et al. Quantitative topographic anatomy of the femoral ACL footprint: a micro-CT analysis. Med Biol Eng Comput 52, 985–995 (2014). https://doi.org/10.1007/s11517-014-1196-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11517-014-1196-0