Anatomic and histologic analysis of the mid-substance and fan-like extension fibres of the anterior cruciate ligament during knee motion, with special reference to the femoral attachment

Mochizuki, Takashi; Fujishiro, Hitomi; Nimura, Akimoto; Mahakkanukrauh, Pasuk; Yasuda, Kazunori; Muneta, Takeshi; Akita, Keiichi

doi:10.1007/s00167-013-2404-4

Cited by 96 publications

(114 citation statements)

References 24 publications

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“…Shino et al reported similar findings with the more detailed histological study [26,27]. However, a recently new concept of the anatomy of the femoral insertion was published by several authors [28,29]. They found by anatomical dissection that the predominantly functioning femoral insertion of ACL existed more anteriorly than was reported [28].…”

Section: Insertion Site Evaluationmentioning

confidence: 58%

Single- Vs. Double-Bundle ACL Reconstruction

Kurosaka

Kuroda

Nagai

2016

ACL Injury and Its Treatment

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Multiple bundle ACL reconstruction, especially focused on doublebundle ACL reconstruction was discussed in this article. Although crucial factors and denominators that influence the outcome of ACL reconstruction are not elucidated, we believe that anatomically oriented graft replacement in reconstruction of the ruptured ACL structure will be certainly the future direction of this surgery. The study of anatomy of the ACL insertion site and intra-articular graft orientation in the young and normal population would be mandatory for the better understanding of future ACL reconstruction. Also better evaluation system that includes both subjective and objective approach should be refined in the future. As the technology advancement is seen in many fields of surgical technique, navigation system or some other types of newer technique will surely be introduced in ACL reconstruction technique field. Biological intervention of ACL surgery is surely one of the challenging issues for future ACL reconstruction. Since ACL is the tissue that has blood supply, biological application to facilitate the implanted graft to heal to normal ACL tissue may be one of the attainable possibilities and may be easier than healing of nonvascularized tissue like an articular cartilage damage or torn meniscus. We are still on the way to get the normal ACL tissue back to the torn ACL knee; however, anatomic approach of the double-bundle ACL reconstruction of the ACL tissue may be one of the possible solutions to this currently unsolved problem for the athletic population.

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Section: Insertion Site Evaluationmentioning

confidence: 58%

Single- Vs. Double-Bundle ACL Reconstruction

Kurosaka

Kuroda

Nagai

2016

ACL Injury and Its Treatment

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“…Although there is no definite reason for the result, previous anatomical studies indicated that the femoral attachment of the ACL can be separated into two different fiber types, the direct insertion and indirect insertion (Mochizuki et al, 2014;Sasaki et al, 2012;Smigielski et al, 2015). The ACL fibers connected to the direct insertion are flexible and can respond to forces from any direction, while the ACL fibers connected to the indirect insertion are simple fibers and work like anchors (Mochizuki et al, 2014;Sasaki et al, 2012). Since the ACL fibers in the lateral layer mainly consist of the former fibers in the femoral attachment, the strain behavior in response to an anterior load may be different as compared with those in the medial and middle fibers.…”

Section: Discussionmentioning

confidence: 99%

Strain distribution in the anterior cruciate ligament in response to anterior drawer force to the knee

Yamakawa

Debski²,

Fujie

2017

JBSE

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In the present study, an image correlation method was used to determine the site-dependent strain in the porcine anterior cruciate ligament (ACL). In particular, the strain of the ACL in the femoral and tibial attachment areas was quantified when the eight knees were subjected to a maximum of 50 N anterior tibial load that was applied using a 6-DOF robotic system. The ACL strains in the anterior, central, and posterior bundles of the medial, middle and lateral layers were determined as a function of the applied anterior load. In addition, the surface of the ACL was observed using a light microscope under no loading condition. Results revealed that the strain in the medial layer of the ACL increased gradually and almost linearly with the increase of anterior load in the midsubstance area. In contrast, the strain in the femoral and tibial attachment areas of the medial layer of the ACL increased rapidly at the beginning of anterior loading and gradually thereafter with significant differences in slope of strain-anterior load curve found in the anterior and posterior bundles. The largest strain in response to 50 N of anterior force was found in the tibial attachment area in medial and middle layers, while the maximum strain was found in the femoral attachment area in the lateral layer. Microscopic observation indicated that crimp structure was more clearly observed in the femoral and tibial attachment areas than in the mid-substance. These microstructural features of the ACL were may be attributable to the higher and load-dependent, nonlinear strain observed in the attachment areas. Our study suggested that the strain in the ACL at full extension is site-and load-dependent in a non-linear manner at the femoral and tibial attachment areas.

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“…Some macroscopic and histologic anatomic studies suggest variability of the normal ACL femoral attachment. Mochizuki et al [12] demonstrated the differences of the indirect insertion area among the subjects, because the variety of the lateral wall shape of the intercondylar notch is not small, but rather quite large. Meanwhile, the direct insertion is narrow and exists constantly at the dome of the intercondylar space and at the posterior cortex of the femoral condyle.…”

Section: Discussionmentioning

confidence: 99%