Comparative Meta-Analysis of ACL Footprint Anatomy Between Asian and Western Populations
Chen Wang1, Ying Ren Mok1, Ming Wang1
1National University Hospital, Singapore.
Background:
The success of anterior cruciate ligament (ACL) reconstruction is influenced by precise anatomic knowledge, which may vary across populations. Despite extensive research on ACL anatomy, direct comparisons between Asian and Western populations remain unexplored.
Purpose/Hypothesis:
The purpose of this study is to systematically compare the footprint size and location of ACL and its individual bundles in Asian and Western populations. It was hypothesized that the ACL footprint size and location of the Asian population would differ from those in the Western population.
Study Design:
Systematic review; Level of evidence, 4.
Methods:
A systematic review and single-arm meta-analysis were conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies on ACL footprint anatomy were included and stratified into subgroups based on the origin of the data (Asian or Western regions). Meta-analyses were performed for femoral and tibial footprint locations of the entire ACL and its anteromedial and posterolateral bundles. The ACL femoral and tibial footprint areas were also compared. Statistical heterogeneity was assessed using a random-effects model.
Results:
A total of 50 studies with 1652 knees were included in the meta-analysis, with 25 studies per subgroup.The center of the ACL femoral footprint was located at 35.2% and 27.3% from the posterior edge of the lateral femoral condyle in the Asian and Western subgroups, respectively (P < .001), and 39.4% and 33% from the Blumensaat line, respectively (P = .049). The Asian subgroup exhibited smaller femoral footprint areas (96.3 mm2 [95% CI, 81.1-111.4] vs 126.8 mm2 [95% CI, 103.5-150]; P = .03). No significant difference was found in the tibial footprint location or size.
Conclusion:
This meta-analysis demonstrated that the ACL femoral footprint in the Asian population is located more anteriorly and distally than in the Western population, and the femoral footprint size is smaller. These findings provide valuable insights for population-specific surgical strategies in the future.
