Aims and objectives
The purpose of this study is to evaluate a detailed anatomy of Anterior cruciate ligament /ACL/ femoral attachment, mid substance and tibial attachment. Anterior cruciate ligament injury is a serious clinical and surgical problem. Injuries of the anterior cruciate ligament /ACL/ are one of the most frequent knee pathologies, and about 100 000 ACL reconstructions are performed each year in US. Even though there are thousands of studies and published papers exploring the subject of ACL injuries, diagnostics and treatment – there is no clear consensus on the best treatment, and many authors report poor long term follow-ups regardless of surgical neither conservative treatment. ACL reconstruction should be based on deep understanding of ACL anatomy and biomechanics, because it is the only way to really restore pre-injury knee kinematics and stability. The radiologist deep understanding of ACL anatomy in CT or MRI exams is a prerequisite for proper diagnosis of ACL tear and evaluation of ACL graft. The 3D CT imaging allows for very good spatial visualization of the anatomical structures. Majority of authors were focused on the shape of ACL footprint and surgical technique to cover that footprint. Or in establishing accurate in vivo method of measuring dimensions of the anterior cruciate ligament bundles by MRI. Although in a few previous publications anterior cruciate ligament is shown as a ribbon-like structure, it was not described in details, neither any conclusion was taken from that anatomical appearance. Describing ACL anatomy as a ribbon-like structure, which – despite of its footprint – forms a ribbon already about 2-3 mm from the femoral attachment, moreover a ribbon that is not above the center of its footprint, but above continuation of the line of posterior femoral cortex – changes the approach to the anatomical ACL reconstruction and as consequence to its diagnostic evaluation.