Anterior cruciate ligament anatomy of Vietnamese adults and applications in arthroscopic anterior cruciate ligament reconstruction surgery with all-inside single-bundle technique.

Abstract

Arthroscopic anterior cruciate ligament (ACL) reconstruction is increasingly performed in Vietnam, with the all-inside technique offering advantages such as minimized invasiveness, reduced postoperative pain, and the ability to use shorter, larger-diameter grafts to lower failure rates. Accurate tunnel placement is critical for optimizing surgical outcomes, and detailed understanding of population-specific ACL anatomy plays an essential role. This study aimed to describe the anatomical characteristics of the ACL in Vietnamese adults and to evaluate clinical outcomes of all-inside single-bundle ACL reconstruction based on these anatomical parameters. Twenty fresh Vietnamese adult knee specimens were dissected to assess ACL length, femoral attachment morphology, tibial attachment morphology, and key anatomical reference distances. Additionally, 68 patients with ACL rupture underwent arthroscopic anatomic reconstruction with a 4-strand hamstring autograft using the all-inside technique and were clinically followed at 3, 6, 12, and 18 months. Functional recovery was assessed using Lysholm and IKDC scores. The mean ACL length was 28.08 ± 1.01 mm. The femoral attachment measured 14.19 ± 1.87 × 11.24 ± 1.76 mm; distances from its center to the Resident's ridge, posterior cartilage, and distal cartilage were 5.67 ± 0.11 mm, 8.26 ± 0.55 mm, and 12.54 ± 0.52 mm, respectively. The tibial attachment measured 13.59 ± 1.57 × 10.67 ± 1.34 mm, with distances to the RER ridge and ACL ridge of 11.63 ± 0.55 mm and 9.46 ± 0.41 mm. Clinically, Lysholm scores improved from 58.84 ± 6.79 preoperatively to 97.8 ± 5.73 at final follow-up. IKDC results showed 54 grade A, 11 grade B, and 3 grade C outcomes, with no reruptures. Applying Vietnamese-specific ACL anatomy in all-inside reconstruction yielded favorable clinical results and represents a promising approach for ACL injuries in Vietnam.