Prof. Mohamed Gouda Montaser Ali Youssef :: Publications:

Athroscopic anterior cruciate ligament (ACL) reconstruction requires an anatomical placement of the bone tunnels. So, the aim of this study was to describe the anatomical positions of the ACL and its bundles relative to arthroscopically visible landmarks. Eighteen intact human cadaveric knees, thirty dried femurs, thirty dried tibiae, ten cases of arthroscopy and twelve cases of magnetic resonance imaging (MRI) scans were used in this study. The number of bundles of ACL, length, width, angle of inclination and twisting of ACL were determined. The shape and site of the femoral and tibial attachment of ACL were recoded. The positions of the centers of anteromedial (AM) bundle, posterolateral (PL) bundle and ACL in relation to notch depth, notch height of the femur, interspinal distance and the length of anterior intercondylar area of the tibia were calculated. There are three types of ACL according to the number of its bundles. The type I consists of one bundle in 40%. The type II consists of two bundles in 57.5%. The type III consists of three bundles in 2.5%. The right ACL is placed between 10– 11 o'clock position, while the left ACL is placed between 1-2 o'clock position. In passive extension and flexion, the average length of ACL is about 334mm. In passive extension the width of ACL is about 102mm, its angle of inclination is about 60-65°, its AM bundle is parallel to the PL bundle. In passive flexion, the width of ACL is about 61mm, its angle is about 50-55, its AM bundle crosses the PL bundle producing twisting. The relative positions of the centres of AMB, PLB and ACL in relation to the notch height is about 1/5 notch height for AMB, 2/5 for PLB and 1/3 for ACL. The relative positions of the centres of AMB, PLB and ACL in relation to the notch depth is about 23.7% of the notch depth for AMB, 30.5% for PLB and 27.1% for ACL. The relative positions of the centres of AMB, PLB and ACL in relation to the interspinal distance is about 30.8% of interspinal distance for AMB, 46.2% for PLB and 38.5% for ACL. The relative positions of the centres of AMB, PLB and ACL in relation to the length of anterior intercondylar area is about 53.8% for AMB, 42.3% for PLB and 48% for ACL. Conclusion: These results are guidelines for the surgeons during the arthroscopic single – bundle or double-bundle recontrucation of ACL.