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Anterior cruciate ligament femoral footprint is oblong-ovate, triangular, or two-tears shaped in healthy young adults: three-dimensional MRI analysis

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study aimed to evaluate the morphology of the anterior cruciate ligament (ACL) femoral footprint with three-dimensional magnetic resonance imaging (3D MRI) in healthy knees.

Methods

Fifty subjects with healthy knees were recruited, utilising 3D-SPACE sequences for ACL evaluation. The ACL was manually segmented, and the shape, size and location of the ACL femoral footprint were evaluated on a reformatted oblique-sagittal plane, which aligned closely with the ACL attachment. Statistical analysis included one-way ANOVA for continuous variables and Fisher's exact test for categorical variables, with a P value < 0.05 considered significant.

Results

Three types of ACL femoral footprint shape were identified, namely, oblong-ovate (OO) in 33 knees (66%), triangular (Tr) in 12 knees (24%) and two-tears (TT) in 5 knees (10%), with the mean areas being 58, 47 and 68 mm2, respectively. Within group TT, regions with similar sizes but different locations were identified: high tear (TT-H) and low tear (TT-L). Notably, group OO demonstrated a larger notch height index, whilst group TT was characterised by a larger α angle and lateral femoral condyle index. A noticeable variation was observed in the location of the femoral footprint centre across groups, with group TT-L and group Tr showing a more distal position relative to the apex of the deep cartilage. According to the Bernard and Hertel (BH) grid, the ACL femoral footprint centres in group TT-L exhibited a shallower and higher position than other groups. Furthermore, compared to group OO and TT-H, group Tr showed a significantly higher position according to the BH grid.

Conclusion

In this study, the morphology of the ACL femoral footprint in healthy young adults was accurately evaluated using 3D MRI, revealing three distinct shapes: OO, Tr and TT. The different ACL femoral footprint types showed similar areas but markedly different locations. These findings emphasise the necessity of considering both the shape and precise location of the ACL femoral footprint during clinical assessments, which might help surgeons enhance patient-specific surgical plans before ACL reconstruction.

Level of evidence

IV.

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Data Availability

The data that support the findings of this study are not openly available due to reasons of sensitivity. Data are, however, available from the corresponding authors upon reasonable request and with permission from the Huashan Hospital institutional ethics review board.

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Acknowledgements

The authors extend their gratitude and appreciation to Professor Pierre-Alexis Mouthuy and Sarah Salmon (Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford) for polishing the language.

Funding

This work was supported by the National Natural Science Foundation of China (No. 82102132) and the Science and Technology Commission of Shanghai Municipality (20S31904300).

Author information

Author notes

  1. Jinrong Lin, Shurong Zhang and Enhui Xin made equal contribution to the work.

Authors and Affiliations

  1. Department of Sports Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong University, 100 Haining Road, Hongkou District, Shanghai, 200080, People’s Republic of China

    Jiwu Chen

  2. Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, People’s Republic of China

    Jinrong Lin & Shurong Zhang

  3. Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Jing’an District, Shanghai, 200040, People’s Republic of China

    Enhui Xin & Liqin Yang

  4. Botnar Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK

    Meng Liang

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Contributions

JWC and LQY, the corresponding author acting as guarantors, led the planning of this work. JRL, SRZ and EHX contributed equally to this work. JWC conceived of the study. JWC, JRL, SRZ, EHX and LQY designed the protocol and performed all data collection. JRL, EHX and ML contributed to the development of the method. JRL, LQY and SRZ conducted the data analysis and reporting. JRL drafted the first version of the manuscript. SRZ, EHX, ML, LQY and JWC critically revised the manuscript and approved its final form. All authors have approved the enclosed manuscript and reported no conflicts of interest.

Corresponding authors

Correspondence to Liqin Yang or Jiwu Chen.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Ethical approval

The approval was obtained from Huashan Hospital institutional ethics review board before commencing the study.

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Written consent was given by all subjects.

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Lin, J., Zhang, S., Xin, E. et al. Anterior cruciate ligament femoral footprint is oblong-ovate, triangular, or two-tears shaped in healthy young adults: three-dimensional MRI analysis. Knee Surg Sports Traumatol Arthrosc 31, 5514–5523 (2023). https://doi.org/10.1007/s00167-023-07606-6

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