Objective To measure precisely the femoral direct insertion bone area of the anterior cruciate ligament (ACL) by using CT three‑dimensional reconstruction, to analyze its correlation with anatomical parameters such as gender and side, to evaluate its clinical guidance value for femoral tunnel positioning in anatomical single-bundle reconstruction, and to conduct a systematic comparison with the IDEAL (isometric, direct insertion, eccentrically located, anatomical, low rupture risk) point positioning method. Methods The 3D CT reconstruction images of knee joints of 553 adult patients (240 males, 260 females; 246 left knees, 307 right knees) admitted to our hospital from February 2024 and August 2025 were retrospectively reviewed. The images were reconstructed using Siemens syngo.via software, and the area, morphological characteristics, and spatial distribution of the femoral direct insertion bone block of ACL were measured using Bernard four-cell table method, followed by statistical analysis. Results The bone block area at the femoral direct attachment site of ACL was (49.86±8.99) mm², concentrated between the posterior cartilage margin and the resident's ridge on the medial surface of lateral femoral condyle. The termination point morphology was mainly of the concave type (89.9%), and the spatial distribution was mainly in zone b (upper front quadrant, 40.5%) and zone d (front lower quadrant, 34.2%), accounting for a combined total of 74.7%. The bone block area in males (52.14±8.63 mm²) was significantly larger than that in females (48.12±8.83 mm²) (P<0.001), with no significant difference in the area between the left and right knee sides. Conclusions CT 3D reconstruction can clearly display the anatomical structure of the direct femoral attachment point of ACL, providing reliable imaging support for ACL reconstruction surgery. The distribution area of the stop point core is consistent with IDEAL point positioning concept, and there are significant gender anatomical differences, therefore, individualized localization principles must be followed during surgery. This study provides anatomical and imaging evidence for the clinical localization of the IDEAL point positioning method.
Key words
CT 3D reconstruction; /
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Anterior cruciate ligament; /
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Direct femoral insertion; /
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Anatomical single-bundle reconstruction; /
IDEAL (isometric, direct insertion, eccentrically located, anatomical, low rupture risk) point
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