Differences in the Microstructural Properties of the Anteromedial and Posterolateral Bundles of the Anterior Cruciate Ligament

Skelley, Nathan W.; Castile, Ryan M.; York, Timothy; Gruev, Viktor; Lake, Spencer P.; Brophy, Robert H.

doi:10.1177/0363546514566192

Cited by 40 publications

(62 citation statements)

References 48 publications

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“…Although the relative elongation patterns were similar in the AMB and PLB, differences in relative elongation of the bundles were observed. Previously observed differences in material and microstructural properties of the AMB and PLB during loading may be an adaptation to relative elongation differences observed in this study. These observed differences in relative strain suggest non‐uniform loading of the fibers of the ACL.…”

Section: Discussionsupporting

confidence: 59%

The Complex Relationship Between In Vivo ACL Elongation and Knee Kinematics During Walking and Running

Nagai

Gale

Chiba

et al. 2019

Journal Orthopaedic Research

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In vivo anterior cruciate ligament (ACL) bundle (anteromedial bundle [AMB] and posterolateral bundle [PLB]) relative elongation during walking and running remain unknown. In this study, we aimed to investigate in vivo ACL relative elongation over the full gait cycle during walking and running. Ten healthy volunteers walked and ran at a self-selected pace on an instrumented treadmill while biplane radiographs of the knee were acquired at 100 Hz (walking) and 150 Hz (running). Tibiofemoral kinematics were determined using a validated model-based tracking process. The boundaries of ACL insertions were identified using high-resolution magnetic resonance imaging (MRI). The AMB and PLB centroid-to-centroid distances were calculated from the tracked bone motions, and these bundle lengths were normalized to their respective lengths on MRI to calculate relative elongation. Maximum AMB relative elongation during running (6.7 ± 2.1%) was significantly greater than walking (5.0 ± 1.7%, p = 0.043), whereas the maximum PLB relative elongation during running (1.1 ± 2.1%) was significantly smaller than walking (3.4 ± 2.3%, p = 0.014). During running, the maximum AMB relative elongation was significantly greater than the maximum PLB relative elongation (p < 0.001). ACL relative elongations were correlated with tibiofemoral six degree-of-freedom kinematics. The AMB and PLB demonstrate similar elongation patterns but different amounts of relative elongation during walking and running. The complex relationship observed between ACL relative elongation and knee kinematics indicates that ACL relative elongation is impacted by tibiofemoral kinematic parameters in addition to flexion/extension. These findings suggest that ACL strain is region-specific during walking and running.

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Section: Discussionsupporting

confidence: 59%

The Complex Relationship Between In Vivo ACL Elongation and Knee Kinematics During Walking and Running

Nagai

Gale

Chiba

et al. 2019

Journal Orthopaedic Research

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“…For many years the anatomy of the ACL was described to have at least two bundles, the anteromedial and posterolateral one. The division was based on anatomical studies and used for biomechanical models 2,3,24,25 . In an attempt to improve clinical results the latest technique developed was to reconstruct the AM and PL bundles separately in a double bundle technique [26][27][28][29] .…”

Section: Discussionmentioning

confidence: 99%

Flat anatomy of ACL and “ribbon like” ACL reconstruction

Kostretzis¹,

Nakamura²,

Siebold³

et al. 2018

JRPMS

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Recent anatomical studies show clear evidence that the anterior cruciate ligament (ACL) has a ribbon like structure from its femoral origin to its tibial attachment. The femoral bony origin of the ACL is half-moon like and the tibial attachment is duck-foot like. On the femoral side the flat midsubstance raise from its origin in a straight line and on the tibial side in a "C"-shaped way. Twisting of the flat ACL from extension to flexion gives the impression of separate bundles. However, no bundles could be found in recent studies. Based on above findings this article introduce a new technique for a flat ACL reconstruction. It was developed to reproduce the native "ribbon like" morphology of the ACL, with a rectangular femoral-and a C-shaped tibial socket.

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“…Gao and Messner () mechanically loaded a range of rabbit knee ligaments, and found that greater frequency and depth of the interdigitations at the bone‐soft tissue interface was positively correlated to the strength of the ligament. Skelley et al (), studying the human ACL showed that the AM bundle was significantly stronger than the PL bundle, but did not include an investigation of the insertions of the respective bundles into bone.…”

Section: Discussionmentioning

confidence: 99%

“…We also suggest that the relatively smooth bone contour and shallow insertion of the PL region of the ACL, closer to the centre and sagittal midline of the joint, reflects its less dominant role in mechanical stabilization. It has been suggested by microstructural property studies that the AM bundle is the primary load bearing region of the ACL with the AM bundle possessing a higher tissue modulus and failure to stress than the PL bundle (Skelley et al, ). The present study reinforces this point, where the difference in insertion morphology between the AM and PL region is consistent with the idea that the AM is more designed for larger loadings than the PL (Benjamin et al, ).…”

Section: Discussionmentioning

confidence: 99%

Microstructure Variations in the Soft‐Hard Tissue Junction of the Human Anterior Cruciate Ligament

Zhao

Lee

Ackland

et al. 2017

The Anatomical Record

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The role of the sub-bundles in the anterior cruciate ligament (ACL) has been defined, such that the anterior-medial bundle directly resists anterior tibial translation while the posterior lateral bundle is involved in rotational stability. With regards to this biomechanical function, much of the previous work on bundle-specific morphology has been carried out on the macroscale, with much less attention given to the micro-to-ultrastructural scalar levels. This is especially true of the enthesis and its microstructure, a biomechanically significant region that has been largely neglected in the published literature dealing with ACL sub-bundle anatomy. In this study, the human ACL tibial enthesis was investigated at multiple scalar levels using differential interference contrast and scanning electron microscopies with the aim of determining whether the sub-bundle ligament structure, and its known macroscale function, is consistent with its micro-architecture at the ligament-bone junction. The investigation found that different ligament insertion morphologies exist between the two bundles, where the AM bundle has more intense interdigitation with the bone matrix than that of the PL bundle. The results suggest that such structure-function relationships, especially across scalar-levels, provide new insight into the significance of the sub-bundle anatomy of the ACL. Anat Rec, 300:1547-1559, 2017. © 2017 Wiley Periodicals, Inc.

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Differences in the Microstructural Properties of the Anteromedial and Posterolateral Bundles of the Anterior Cruciate Ligament

Abstract: These insights into native ligament microstructure can be used to assess graft options for ACL reconstruction and optimize surgical reconstruction techniques.

Cited by 40 publications

References 48 publications

The Complex Relationship Between In Vivo ACL Elongation and Knee Kinematics During Walking and Running

The Complex Relationship Between In Vivo ACL Elongation and Knee Kinematics During Walking and Running

Flat anatomy of ACL and “ribbon like” ACL reconstruction

Microstructure Variations in the Soft‐Hard Tissue Junction of the Human Anterior Cruciate Ligament

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