(Fig 2-C.07) Bi-dimensional sagittal inclination

https://youtu.be/o5FY-l_g16s

https://youtu.be/uDgqFi3itg0

Bi-dimensional Sagittal Inclination of the ACL

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1️⃣ Definition and Importance

• The sagittal angle is crucial in understanding the anterior cruciate ligament (ACL) dynamics. It is defined as the angle between the anterior margin of the ACL and a line perpendicular to the long axis of the tibia.
• This measurement is best obtained from a midline image that clearly depicts the ACL.

2️⃣ Native ACL Sagittal Inclination Range

• Research indicates that the native ACL sagittal inclination ranges between 50°-60°.
• It is advised that the graft inclination after ACL reconstruction should not exceed 60° to maintain the natural mechanics of the knee joint.

📌Variability in Published Findings

Studies have shown a wide variability in the measurements of the native ACL inclination angle:

• Sagittal Plane: Ranges between 43° and 57°.
• Coronal Plane: Ranges from 65° to 76°.

Knee Surg Sports Traumatol Arthrosc. 2017 Apr;25(4):1101-1105.

📌A sagittal graft inclination greater than 60° is associated with increased laxity following ACL reconstruction.

3️⃣ Influencing Factors on Graft Inclination

Several factors can influence the outcome of graft inclination, including Surgical experience, Knee anatomy, and Surgical technique

📌Surgical Techniques and Graft Inclination

• Trans-tibial (TT) Femoral Tunnel Drilling: Tends to result in more vertical grafts in the sagittal plane, averaging around 72°.
• Anteromedial Portal (AMP) Drilling: Results in less vertical grafts, with an average inclination of 53°.

Knee Surg Sports Traumatol Arthrosc 2009; 17: 880-886

World J Orthop. 2016 Oct 18;7(10):638-649

 

 

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