Significant race and gender differences in anterior cruciate ligament tibial footprint location: a 3D-based analysis

Lihang Zhang; Changzhao Li; Jiaying Zhang; Diyang Zou; Dimitris Dimitriou; Xing Xing; Tsung-Yuan Tsai; Pingyue Li

doi:10.1186/s10195-023-00710-w

Significant race and gender differences in anterior cruciate ligament tibial footprint location: a 3D-based analysis

J Orthop Traumatol. 2023 Jun 30;24(1):33. doi: 10.1186/s10195-023-00710-w.

Authors

Lihang Zhang^#¹, Changzhao Li^#¹, Jiaying Zhang^#², Diyang Zou^{3

4

5}, Dimitris Dimitriou⁶, Xing Xing^{7

8}, Tsung-Yuan Tsai^{9

10

11}, Pingyue Li¹²

Affiliations

¹ Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China.
² Department of Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China.
³ School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.
⁴ Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.
⁵ Shanghai Key Laboratory of Orthopedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁶ Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland.
⁷ Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University, N.W. Washington, DC, USA.
⁸ Department of Social Medicine and Health Management, School of Public Health, Peking University, Beijing, People's Republic of China.
⁹ School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China. tytsai@sjtu.edu.cn.
¹⁰ Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China. tytsai@sjtu.edu.cn.
¹¹ Shanghai Key Laboratory of Orthopedic Implants and Clinical Translational R&D Center of 3D Printing Technology, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. tytsai@sjtu.edu.cn.
¹² Guangdong Key Lab of Orthopedic Technology and Implant, General Hospital of Southern Theater Command of PLA,The First School of Clinical Medicine, Southern Medical University, Guangzhou, China. lipingyue09@126.com.

^# Contributed equally.

Abstract

Background: The aim of the present study was to identify potential race- or gender-specific differences in anterior cruciate ligament (ACL) tibial footprint location from the tibia anatomical coordinate system (tACS) origin, investigate the distances from the tibial footprint to the anterior root of the lateral meniscus (ARLM) and the medial tibial spine (MTS), determine how reliable the ARLM and MTS can be in locating the ACL tibial footprint, and assess the risk of iatrogenic ARLM injuries caused by using reamers with various diameters (7-10 mm).

Patients and methods: Magnetic resonance images of 91 Chinese and 91 Caucasian subjects were used for the reconstruction of three-dimensional (3D) tibial and ACL tibial footprint models. The anatomical coordinate system was applied to reflect the anatomical locations of scanned samples.

Results: The average anteroposterior (A/P) tibial footprint location was 17.1 ± 2.3 mm and 20.0 ± 3.4 mm in Chinese and Caucasians, respectively (P < .001). The average mediolateral (M/L) tibial footprint location was 34.2 ± 2.4 mm and 37.4 ± 3.6 mm in Chinese and Caucasians, respectively (P < .001). The average difference between men and women was 2 mm in Chinese and 3.1 mm in Caucasians. The safe zone for tibial tunnel reaming to avoid ARLM injury was 2.2 mm and 1.9 mm away from the central tibial footprint in the Chinese and Caucasians, respectively. The probability of damaging the ARLM by using reamers with various diameters ranged from 0% for Chinese males with a 7 mm reamer to 30% in Caucasian females with a 10 mm reamer.

Conclusions: The significant race- and gender-specific differences in the ACL tibial footprint should be taken in consideration during anatomic ACL reconstruction. The ARLM and MTS are reliable intraoperative landmarks for identifying the tibial ACL footprint. Caucasians and females might be more prone to iatrogenic ARLM injury.

Level of evidence: III, cohort study.

Trial registration: This study has been approved by the ethical research committee of the General Hospital of Southern Theater Command of PLA under the code: [2019] No.10.

Keywords: Anterior cruciate ligament; Ethnicity; Gender; Iatrogenic injury; Landmarks; Single-bundle reconstruction; Tibial attachment.

MeSH terms

Anterior Cruciate Ligament* / diagnostic imaging
Anterior Cruciate Ligament* / surgery
Cohort Studies
Female
Humans
Iatrogenic Disease
Male
Sex Factors
Tibia*

Abstract

MeSH terms

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