Fig 1.
Anatomy of the ACL insertion sites. Smigielski et al.3 describe the femoral insertion site as crescent-shaped, extending from the intercondylar ridge to the posterior articular margin of the lateral condyle, shown in schematic (A) and in a right cadaveric lateral femoral condyle viewed from medially, with the medial condyle removed (B). The native ACL insertion consists of 2 components: the direct type (dark blue), where fibers entered the bone almost at a right angle and the fanlike indirect fibers (light blue) extending to the articular margin. The location of a rectangular tunnel for reconstruction (green) is shown according to these landmarks. The tibial insertion is described as being C-shaped3,4 from along the lateral edge of the medial tibial spine to the anterior aspect of the anterior root of the lateral meniscus, accommodating within its concavity the insertion of the lateral meniscus. This relation is shown in a schematic drawing of a right tibial plateau viewed from above (C) with the native ACL insertion (light blue) and the C-shaped tunnel (green). (D) Illustration of the corresponding view of a right cadaveric tibial plateau with the native ACL resected 1 cm above its insertion site to demonstrate its relationship to the anterior root of the lateral meniscus. (ACL, anterior cruciate ligament.)