Three-dimensional surface area of the anterior cruciate ligament tibial insertion, and its correlation with the anatomical characteristics of the proximal tibia

• Published in: Medicinski pregled Vol. 77; no. 9-12; pp. 291 - 297
• Main Authors: Kovacev, Nemanja, Milojevic, Zoran, Milovic, Milan, Milankov, Vukadin
• Format: Journal Article
• Language: English
• Published: 2024
• ISSN: 0025-8105; 1820-7383
• DOI: 10.2298/MPNS2412291K

Introduction. Precise positioning of the tibial tunnel is crucial for successful anterior cruciate ligament (ACL) reconstruction. By correlating the ACL attachment area on the tibia with tibial plateau dimensions measured on two preoperative standard radiographs, it is possible to determine the optimal drilling angle preoperatively. Material and Methods. This study examined 32 tibial specimens with ACL attachments obtained during total knee arthroplasty. Anteroposterior and lateral preoperative radiographs were used to measure tibial plateau dimensions. A 3D scan of the ACL attachment area, performed with a Personal HAptic iNTerface Mechanism Omni device, provided two new measurements: the ACL attachment surface area (mm.) and its projection on the tibia (mm.). Results. The average anteroposterior and mediallateral diameters of the tibial plateau were 47.81 mm and 71.94 mm, respectively. The mean ACL attachment area was 142.4 mm., and the average projection area was 110.2 mm.. Multiple regression analysis demostrated statistically significant correlations between tibial plateau dimensions and the ACL attachment area. Mathematical-statistical procedures yielded formulas for predicting the attachment surface area (P = 7.585 x AP - 0.179 x ML - 207.319) and its projection (P = 3.466 x AP + 1.261 x ML - 146.218) based on measured anteroposterior and medial-lateral diameters of the tibial plateau. Conclusion. Standard radiographic measurements of the tibial plateau allow for accurate prediction of the ACL attachment area. Combined with drill bit diameter, these data support individualized determination of the tibial tunnel drilling angle, enhancing surgical precision in ACL reconstruction.