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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (3): 586-590. doi: 10.19723/j.issn.1671-167X.2019.03.031

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Anatomical and finite element analysis of anterior cruciate ligament reconstruction within biomechanical insertion

Jia-hao ZHANG,Shuang REN,Jia-yi SHAO,Xing-yue NIU,Xiao-qing HU,Ying-fang AO△()   

  1. Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
  • Received:2019-03-13 Online:2019-05-14 Published:2019-06-26
  • Supported by:
    Supported by the Fundamental Research funds for the Central Universities: Peking University Clinical Scientist Program(BMU2019LCKXJ008), and Grant from the Major Clinical Project of Peking University Third Hospital(BYSY2018005)

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Abstract: Objective: To provide new concepts of anterior cruciate ligament (ACL) reconstruction by anatomical gross observation of ACL tibial insertion and finite element analysis of distribution of ACL mechanical insertion.Methods: In the anatomical study, ten fresh adult cadaveric knees were dissected, including 6 males and 4 females, all knees were generally observed through standard medial parapatellar approaches, paying attention to the close anatomical relationship of tibial insertion and anterior horn of lateral meniscus, and ACL was exposed and gradually removed from the inside. The shape of tibial insertion of ACL was observed and recorded, and anterior-posterior diameters and left-right diameters of tibial insertion were measured with vernier caliper. For the study of finite element analysis, three-dimensional thin-layer magnetic resonance imaging of normal knee joint was used to establish knee joint model. Three-dimensional reconstruction software MIMICS and finite element analysis software ANSYS were used to establish knee joint model, subsequently, clinical physical examination Lachman test and pivot-shift test were simulated to observe the force distribution of ACL tibial insertion and femoral insertion. Results: The ACL tibial mechanical insertion was rather flat and long similar as an arc shape without a clear separation between anterior medial bundle (AMB) and posterolateral bundle (PLB) in gross observation. The dense fibers lies belonged to the medial intercondylar ridge and ended up anterior with the osseous landmark of anterior ridge. Its average anterior-posterior diameter was (13.8±2.0) mm, the average left-right diameter of midsubstance was (5.3±0.6) mm, and the average left-right diameter of anterior margin was (11.5±1.2) mm. The finite element analysis showed that distribution on the femoral side was oval shape mainly below the residents’ ridge, while the tibial side was rather flat mainly along the medial intercondylar ridge, which was consistent with the anatomical observation. The biomechanical characteristics of ACL attachments were verified theoretically.Conclusion: Anatomical study and finite element analysis have confirmed the flat arc shape of ACL tibial insertion. The ideal reconstruction technique of ACL should be based on its biomechanical insertion. Based on anatomical study and biomechanical analysis, we have proposed the idea of ACL biomechanical insertion reconstruction (BIR) and established a surgical model with oval femoral tunnel and rounded-rectangle tibial tunnel.

Key words: ACL reconstruction, Tibial insertion, Anatomy, Finite element analysis, Biomechanical

CLC Number: 

  • R329.4

Figure 1

Specimen measurement A, anterior cruciate ligament(ACL)tibial insertion extent; B, width measurement of midsubstance of ACL tibial insertion with vernier caliper;a, the anterior-posterior diameter of ACL tibial insertion; b, the width of midsubstance of ACL tibial insertion; c, the width of anterior margin of ACL tibial insertion."

Figure 2

von Mises stress distribution on the femoral side (A) and tibial side (B)with Lachman test"

Figure 3

von Mises stress distribution on the femoral side (A)and tibial side (B)with pivot-shift test"

Figure 4

Sectional sketch view of bone tunnel A,sectional view of round bone tunnel; B, sectional view of rounded-rectangle tibial tunnel of ACL-BIR; C, sectional view of oval femoral tunnel of ACL-BIR."

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