Histological and cellular evaluation of anterior cruciate ligament

Butt, Umer; Khan, Zainab; Zahir, Naila; Khan, Zahid; Vuletić, Filip; Shah, Imran; Shah, Junaid Ali; Siddiqui, Athar M; Hudetz, Damir

doi:10.1016/j.knee.2020.08.002

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…Anterior cruciate ligament (ACL) tear is one of the most serious concerns in athletes [1][2][3][4]. Those who sufer ACL injuries have been reported to display certain characteristic risk factors such as joint laxity, muscle weakness, and more [4][5][6][7][8][9]. Certain knee morphological variations have been reported to have a strong correlation with the occurrence of ACL injury as well [2,5,[9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…Those who sufer ACL injuries have been reported to display certain characteristic risk factors such as joint laxity, muscle weakness, and more [4][5][6][7][8][9]. Certain knee morphological variations have been reported to have a strong correlation with the occurrence of ACL injury as well [2,5,[9][10][11][12][13]. Of these, intercondylar notch size in particular has been frequently evaluated and correlations with the occurrence of ACL injury have been reported [2,7,[14][15][16].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Knees with straight Blumensaat’s line have small volume of femoral intercondylar notch

Iriuchishima¹,

Goto²,

Byrne

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose Smaller femoral intercondylar notch volume has been identiied as a risk factor for anterior cruciate ligament injury. The present study aims to investigate diferences in the intercondylar notch volume based on diferences in the morphology of Blumensaat's line. Methods Eighty-eight (88) subjects (42 male and 46 female: median age 27: range 15-49), were included in this study. Using 3-dimensional computed tomography (3D-CT), the volume of the intercondylar notch was calculated using a truncatedpyramid shape simulation with the formula: Volume = .h(S1 + S2 + √ (S1S2))∕3 . Femoral condyle height (h) was measured in the sagittal plane of the knee in 3D-CT. The area of the intercondylar notch was measured in the axial slice containing the most proximal level (S1) and most distal level (S2) of Blumensaat's line. In the sagittal view of the knee, Blumensaat's line morphology was classiied into either straight or hill type. Statistical analysis was performed to compare h, S1, S2, and notch volume between the straight and hill type groups. Results Thirty-six subjects were classiied as having straight type morphology and 52 subjects were classiied as having hill type morphology. The measured h, S1, and S2, of the straight and hill types were 29 ± 4 and 31 ± 4 mm, 213 ± 72 and 205 ± 51 mm 2 , 375 ± 114 and 430 ± 94 mm 2 , respectively. The calculated femoral intercondylar notch volume of the straight and hill types was 8.1 ± 2 and 9.5 ± 2 cm 3 , respectively. Straight type knees showed signiicantly smaller S2 (p = 0.04), and notch volume (p = 0.01) when compared with hill type knees. Conclusion Intercondylar notch volume was signiicantly smaller in knees with straight type Blumensaat's line morphology. Considering that Blumensaat's line represents the roof of the femoral notch, morphological variations in Blumensaat's line are likely to relect variation in notch volume. For clinical relevance, as a smaller notch volume is a risk factor for ACL injury, straight type Blumensaat's line may also be considered a potential risk factor for ACL injury. Level of evidence Level III.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Knees with straight Blumensaat’s line have small volume of femoral intercondylar notch

Iriuchishima¹,

Goto²,

Byrne

et al. 2021

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

show abstract

“…Upon complete tear, the ligament is totally unable to self‐regenerate into a coherent and organized functional tissue, requiring clinical intervention. [ 2 ] Current clinical approaches to reconstruct torn intra‐articular ligaments, however, fail to reproduce the multi‐zonal structure of the ligaments responsible for stress transfer between bones and require the use of autografts, associated with donor site morbidity.…”

Section: Introductionmentioning

confidence: 99%

Mimicking the Graded Wavy Structure of the Anterior Cruciate Ligament

Camarero‐Espinosa

Yuan

Emans

et al. 2023

Adv Healthcare Materials

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Anterior cruciate ligament (ACL) is the connective tissue providing mechanical stability to the knee joint. ACL reconstruction upon rupture remains a clinical challenge due to the high mechanical properties required for proper functioning. ACL owes its outstanding mechanical properties to the arrangement of the extracellular matrix (ECM) and to the cells with distinct phenotypes present along the length of the tissue. Tissue regeneration appears as an ideal alternative. In this study, a tri-phasic fibrous scaffold that mimics the structure of collagen in the native ECM is developed, presenting a wavy intermediate zone and two aligned uncurled extremes. The mechanical properties of the wavy scaffolds present a toe region, characteristic of the native ACL, and an extended yield and ultimate strain compared to aligned scaffolds. The presentation of a wavy fiber arrangement affects cell organization and the deposition of a specific ECM characteristic of fibrocartilage. Cells cultured in wavy scaffolds grow in aggregates, deposit an abundant ECM rich in fibronectin and collagen II, and express higher amounts of collagen II, X, and tenomodulin as compared to aligned scaffolds. In vivo implantation in rabbits shows a high cellular infiltration and the formation of an oriented ECM compared to aligned scaffolds.

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“…However, in the period of tissue necrosis and new tissue ingrowth, the graft failure load is significantly reduced and it is easy to damage again. A large number of biological and animal experiments have shown that the preservation of ACL remnant can accelerate the synovial coverage of the transplanted ligament, reduce synovial fluid invasion of the transplanted ligament and the inner wall of the bone tunnel, and promote revascularization, ligamentization, and tendon-bone healing ( 7 – 10 ). Beside, residual proprioceptors in the ACL remnant still play a role in stabilizing the knee after ACL injury ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Effects of remnant preservation in anterior cruciate ligament reconstruction: A systematic review and meta-analysis

Xie

Zhong

et al. 2022

Front. Surg.

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BackgroundCompared with standard anterior cruciate ligament (ACL) reconstruction, it is controversial whether anterior cruciate ligament reconstruction (ACLR) with remnant preservation can lead to better clinical outcomes. We conducted a systematic study and meta-analysis to assess the differences in clinical efficacy between the two.MethodWe searched for clinical randomized controlled studies and cohort studies included in the Cochrane library, PubMed, and Embase from March 2012 to March 2022 in English. The included studies were ACLR with or without remant preservation, and the data were extracted and the quality of the included studies was assessed by two authors, respectively. Revman 5.4 was used for statistical analysis and conclusions were presented.ResultTen articles containing a total of 777 patients were finally included. There was no significant difference in postoperative Lachman test [OR = 1.66, 95%CI (0.79, 3.49), P = 0.18 > 0.05], Tegner score [SMD = −0.13, 95%CI (−0.47, 0.22), P = 0.46 > 0.05], synovial coverage rate by second-look arthroscopy [OR = 1.55, 95%CI (0.66, 3.65), P = 0.32 > 0.05], the rate of cyclops lesion [OR = 3.92, 95%CI (0.53, 29.29), P = 0.18 > 0.05], joint range of motion [SMD = 0.27, 95%CI (−0.13, 0.68), P = 0.19 > 0.05] and re-injury rate [OR = 0.57, 95%CI (0.18, 1.74), P = 0.32 > 0.05] between the two groups. There were statistically significant differences in postoperative Lysholm score [SMD = 0.98, 95% CI (0.32, 1.64), P = 0.004 < 0.05], International Knee Documantation Committee grade (IKDC grade) [OR = 2.19, 95%CI (1.03, 4.65), P = 0.04 < 0.05], Pivot shift test [OR = 1.71, 95%CI (1.06, 2.77), P = 0.03 < 0.05], KT1000/2000 arthrometer side-to-side difference [SMD = −0.22, 95%CI (−0.42, −0.03), P = 0.02 < 0.05], operation time [SMD = 11.69, 95%CI (8.85, 14.54), P = 0.00001 < 0.05] and degree of tibial tunnel enlargement [SMD = −0.66, 95%CI (−1.08, −0.23), P = 0.002 < 0.05].ConclusionThis meta-analysis concluded that remnant preservation significantly had better results in terms of patient functional score (Lysholm, IKDC), knee stability (Pivot shift test, postoperative side-to-side anterior laxity) and tibial tunnel enlargement. In terms of complications (incidence of Cyclops lesions, range of motion, re-injury rate), no significant differences were seen between the two groups. Although many studies concluded that remnant preservation could bring better synovial coverage, this meta-analysis indicated that there is insufficient evidence to support it, possibly due to different remnant preservation procedures.The potential risks associated with longer operation times are also worth considering.

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Histological and cellular evaluation of anterior cruciate ligament

Cited by 8 publications

References 15 publications

Knees with straight Blumensaat’s line have small volume of femoral intercondylar notch

Knees with straight Blumensaat’s line have small volume of femoral intercondylar notch

Mimicking the Graded Wavy Structure of the Anterior Cruciate Ligament

Effects of remnant preservation in anterior cruciate ligament reconstruction: A systematic review and meta-analysis

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