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JRPMS Vol 2, No 4, December 2018, p.113-117

doi: 10.22540/JRPMS-02-113


Original Article

Flat anatomy of ACL and “ribbon like” ACL reconstruction

Lazaros Kostretzis1, Kaori Nakamura1, Maja Siebold1, Christian Fink2, Robert Smigielski3, Rainer Siebold1,4

  1. HKF-International Center for Hip-Knee-Foot Surgery, ATOS Hospital Heidelberg, Germany
  2. Gelenkpunkt-Sports and Joint Surgery, Innsbruck, Austria
  3. Trauma and Orthopaedics Department, “Mirai” Institute for Orthopaedics and Physical Therapy, Warsaw, Poland
  4. Institute for Anatomy and Cell Biology, Ruprecht-Karls University, Heidelberg, Germany

Keywords: Ribbon-like ACL reconstruction, Flat ACL anatomy, Anterior cruciate ligament, Flat graft, C-shape


Recent anatomical studies show clear evidence that the anterior cruciate ligament (ACL) has a ribbon like structure from its femoral origin to its tibial attachment. The femoral bony origin of the ACL is half-moon like and the tibial attachment is duck-foot like. On the femoral side the flat midsubstance raise from its origin in a straight line and on the tibial side in a “C”-shaped way. Twisting of the flat ACL from extension to flexion gives the impression of separate bundles. However, no bundles could be found in recent studies. Based on above findings this article introduce a new technique for a flat ACL reconstruction. It was developed to reproduce the native “ribbon like” morphology of the ACL, with a rectangular femoral- and a C-shaped tibial socket.