Takeshi Muneta1,2, Hideyuki Koga3, Tomomasa Nakamura3, Masafumi Horie3, Toshifumi Watanabe3, Ichiro Sekiya3. 1. Department of Orthopaedic Surgery, Tokyo Medical and Dental University Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. muneta.orj@tmd.ac.jp. 2. Department of Joint Surgery and Sports Medicine, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan. muneta.orj@tmd.ac.jp. 3. Department of Orthopaedic Surgery, Tokyo Medical and Dental University Medical Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Abstract
PURPOSE: To describe the femoral anterior cruciate ligament (ACL) attachment based on the behind-remnant observation with a new scoring system and to investigate the characteristics of an ACL injured knee. METHODS: One hundred and twenty-six ACL injured knees with four standardized arthroscopic photos and full evaluation under anaesthesia were included in the study. Sixty non-ACL injured knees were also evaluated as control. A scoring system for the femoral ACL attachment was set as follows based on behind-remnant findings; the direct insertion was divided into three portions as proximal, middle and distal. The fibrous extension from the articular surface (indirect insertion) and the severity of synovitis were also graded into 2, 1 and 0 points. The total score was 10 as full marks. The correlation between each score and total score, as well as age at surgery, gender, anterior laxity, pivot-shift test and meniscus injuries, was statistically evaluated with a significance of 0.05. RESULTS: The femoral attachment score of the ACL injured knees was statistically different from that of the non-ACL injured knees. Anterior laxity was dependent only on the integrity of the proximal portion. Knee instability was significantly correlated with the status of the direct insertion. Medial and lateral meniscus injuries were correlated with the middle part and the distal part of the direct insertion, respectively. The direct insertion was less preserved in distal and articular sides. CONCLUSION: Arthroscopic observation behind the remnant of the injured ACL showed clearer findings of the femoral attachment than that from the front. Behind-remnant observation greatly assists in the creation of a correct anatomical tunnel with the preserving remnant. The scoring system indicated several significant correlations between the score and preoperative patient status.
PURPOSE: To describe the femoral anterior cruciate ligament (ACL) attachment based on the behind-remnant observation with a new scoring system and to investigate the characteristics of an ACL injured knee. METHODS: One hundred and twenty-six ACL injured knees with four standardized arthroscopic photos and full evaluation under anaesthesia were included in the study. Sixty non-ACL injured knees were also evaluated as control. A scoring system for the femoral ACL attachment was set as follows based on behind-remnant findings; the direct insertion was divided into three portions as proximal, middle and distal. The fibrous extension from the articular surface (indirect insertion) and the severity of synovitis were also graded into 2, 1 and 0 points. The total score was 10 as full marks. The correlation between each score and total score, as well as age at surgery, gender, anterior laxity, pivot-shift test and meniscus injuries, was statistically evaluated with a significance of 0.05. RESULTS: The femoral attachment score of the ACL injured knees was statistically different from that of the non-ACL injured knees. Anterior laxity was dependent only on the integrity of the proximal portion. Knee instability was significantly correlated with the status of the direct insertion. Medial and lateral meniscus injuries were correlated with the middle part and the distal part of the direct insertion, respectively. The direct insertion was less preserved in distal and articular sides. CONCLUSION: Arthroscopic observation behind the remnant of the injured ACL showed clearer findings of the femoral attachment than that from the front. Behind-remnant observation greatly assists in the creation of a correct anatomical tunnel with the preserving remnant. The scoring system indicated several significant correlations between the score and preoperative patient status.
Authors: K L Markolf; D M Burchfield; M M Shapiro; B R Davis; G A Finerman; J L Slauterbeck Journal: J Bone Joint Surg Am Date: 1996-11 Impact factor: 5.284