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Size and Shape of the Human Anterior Cruciate Ligament and the Impact of Sex and Skeletal Growth

A Systematic Review

Cone, Stephanie G. BS1,2,*; Howe, Danielle BS1,2,*; Fisher, Matthew B. PhD1,2,3

doi: 10.2106/JBJS.RVW.18.00145
Evidence-Based Systematic Reviews
Supplementary Content

Background: High rates of anterior cruciate ligament (ACL) injury and surgical reconstruction in both skeletally immature and mature populations have led to many studies investigating the size and shape of the healthy ligament. The purposes of the present study were to compile existing quantitative measurements of the geometry of the ACL, its bundles, and its insertion sites and to describe effects of common covariates such as sex and age.

Methods: A search of the Web of Science was conducted for studies published from January 1, 1900, to April 11, 2018, describing length, cross-sectional area, volume, orientation, and insertion sites of the ACL. Two reviewers independently screened and reviewed the articles to collect quantitative data for each parameter.

Results: Quantitative data were collected from 92 articles in this systematic review. In studies of adults, reports of average ACL length, cross-sectional area, and volume ranged from 26 to 38 mm, 30 to 53 mm2, and 854 to 1,858 mm3, respectively. Reported values were commonly found to vary according to sex and skeletal maturity as well as measurement technique.

Conclusions: Although the geometry of the ACL has been described widely in the literature, quantitative measurements can depend on sex, age, and measurement modality, contributing to variability between studies. As such, care must be taken to account for these factors. The present study condenses measurements describing the geometry of the ACL, its individual bundles, and its insertion sites, accounting for common covariates when possible, to provide a resource to the clinical and scientific communities.

Clinical Relevance: Quantitative measures of ACL geometry are informative for developing clinical treatments such as ACL reconstruction. Age and sex can impact these parameters.

1Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina–Chapel Hill, Raleigh, North Carolina

2Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina

3Department of Orthopaedics, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina

E-mail address for M.B. Fisher:

*Stephanie G. Cone, BS, and Danielle Howe, BS, contributed equally to this work.

Investigation performed at the Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina–Chapel Hill, Raleigh, North Carolina

Disclosure: Funding was provided by National Institutes of Health (NIH) (AR-068112 and AR-071985) and National Science Foundation (NSF) (DGE-1252376) grants. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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