Tibial Insertion of the ACL: 3D-CT Images, Macroscopic, and Microscopic Findings

Accurate and detailed knowledge of ACL footprint anatomy is essential for successful anatomical ACL reconstruction. On the femoral side, the discovery of bony landmarks led to the standardization of femoral bone tunnel construction; however, the detailed morphology and location of ACL tibial footprint continue to be a topic of debate, and there are still no standardized methods for tibial tunnel construction. We previously reported the ACL tibial attachment site anatomy and bony landmarks and compared 3D images with visual and histological evaluations. The results from the study found a unique bony landmark surrounding the ACL attachment site, showing the relationship of these bony landmarks and surrounding anatomical landmarks as a useful indicator for determining tunnel positions during arthroscopic surgery. This section will clarify the detailed anatomy and bony landmark of the ACL tibial footprint necessary for reconstructive surgery by reviewing our previous research in conjunction with the available literature.