¿Está el ligamento realmente «caído»?

The concept of a “fallen” Anterior Cruciate Ligament (ACL) refers to the wrong conception of the native ACL based on the orientation, tension and appearance of a transtibial, non-anatomic, vertical ACL graft. This appearance could be considered as the appearance of a normal ligament. When, later, we see an uninjured ACL, anatomically orientated and inserted in its footprint, we could think of it as “fallen”. The fact is that that is its anatomic insertion.

The tension pattern can also confuse us because that of the native ligament varies throughout the range of flexion-extension whilst non-anatomic grafts, being isometric, are always tense.

The fact that the study of the anatomy as well as imaging tests are done with the knee in full extension but arthroscopy is performed with the knee in 90° of flexion adds confusión to the perception of the uninjured ligament.

We must discard the concept of the “fallen” ligament and take this opportunity to better understand the anatomy of the femoral footprint, the tension, and the real orientation of the ligament.