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Related Experiment Video

Updated: Apr 29, 2026

Surgical Retrieval, Isolation and In vitro Expansion of Human Anterior Cruciate Ligament-derived Cells for Tissue Engineering Applications
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Is the native ACL insertion site "completely restored" using an individualized approach to single-bundle ACL-R?

K K Middleton1, B Muller1,2, P H Araujo1,3

  • 1Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA, 15203, USA.

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA
|May 15, 2014
PubMed
Summary

Individualized anatomic anterior cruciate ligament reconstruction (ACL-R) techniques do not fully restore the native insertion site. This study introduces a method to measure the percentage of reconstructed area, aiding future research on complete footprint restoration.

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Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Biomechanical Engineering

Background:

  • Anterior cruciate ligament reconstruction (ACL-R) aims to replicate native insertion sites.
  • The extent of native footprint restoration by current ACL-R techniques is not well understood.
  • Quantifying tunnel aperture area relative to native insertion sites is crucial for evaluating technique efficacy.

Purpose of the Study:

  • To determine if individualized anatomic ACL-R maximally fills the native insertion site.
  • To establish a metric for evaluating the percentage of reconstructed area.
  • To lay the groundwork for understanding the clinical implications of complete footprint restoration in ACL-R.

Main Methods:

  • Prospective pilot study of 45 patients undergoing primary single-bundle anatomic ACL-R.
  • Intraoperative measurement of native femoral and tibial insertion site dimensions.
  • Calculation of native and tunnel aperture areas using elliptical formulas and drill parameters.
  • Determination of percentage of reconstructed area by comparing tunnel aperture area to native insertion site area.

Main Results:

  • Mean native femoral insertion site area was 83 mm², and tibial was 125 mm².
  • Mean femoral tunnel aperture area was 65 mm², and tibial was 86 mm².
  • Average reconstructed area was 79% on the femoral side and 70% on the tibial side.

Conclusions:

  • Current individualized anatomic ACL-R techniques do not completely restore the native insertion site.
  • Percentage of reconstructed area provides a basic measure for assessing native footprint coverage.
  • This metric serves as a foundation for investigating the clinical significance of achieving complete footprint restoration in ACL-R.