The Femoral Insertion of the Anterior Cruciate Ligament: Discrepancy Between Macroscopic and Histological Observations

Sasaki, Nozomu; Ishibashi, Yasuyuki; Tsuda, Eiichi; Yamamoto, Yuji; Maeda, Shugo; Mizukami, Hiroki; Toh, Satoshi; Yagihashi, Soroku; Tonosaki, Yoshikazu

doi:10.1016/j.arthro.2011.12.021

Cited by 146 publications

(171 citation statements)

References 39 publications

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“…The thickening found was similar in magnitude to that found in the histological study by Sasaki et al 22 of the bone layer at the ACL insertion point. A different pattern was seen on the medial femoral condyle with cortical thickening seen much more anteriorly, consistent with the attachment of the posterior cruciate ligament.…”

Section: Discussionsupporting

confidence: 75%

Cortical Bony Thickening of the Lateral Intercondylar Wall: The Functional Attachment of the Anterior Cruciate Ligament

et al. 2016

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Background: The anatomy of the anterior cruciate ligament (ACL) has become the subject of much debate. There has been extensive study into attachment points of the native ligament, especially regarding the femoral attachment. Some of these studies have suggested that fibers in the ACL are of differing functional importance. Fibers with higher functional importance would be expected to exert larger mechanical stress on the bone. According to Wolff’s law, cortical thickening would be expected in these areas. Purpose: To examine cortical thickening in the region of the ACL footprint (ie, the functional footprint of the ACL). Study Design: Descriptive laboratory study. Methods: Using micro–computed tomography with resolutions ranging from 71 to 91 μm, the cortical thickness of the lateral wall of the intercondylar notch in 17 cadaveric knees was examined, along with surface topography. After image processing, the relationship between the cortical thickening and surface topology was visually compared. Results: A pattern of cortical thickening consistent with the functional footprint of the ACL was found. On average, this area was 3 times thicker than the surrounding bone and significantly thicker than the remaining lateral wall ( P < .0001). This thickening was roughly elliptical in shape (with a mean centroid at 23.5 h:31 t on a Bernard and Hertel grid) and had areas higher on the wall where greater thickness was present. The relationship to previously reported osseous landmarks was variable, although the patterns were broadly consistent with those reported in previous studies describing direct and indirect fibers of the ACL. Conclusion: The findings of this study are consistent with those of recent studies describing fibers in the ACL of differing functional importance. The area in which the thickening was found has been defined and is likely to represent the functional footprint of the ACL. Clinical Relevance: This information is of value to surgeons when determining the optimal place to position the femoral attachment site of the reconstructed ACL.

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Section: Discussionsupporting

confidence: 75%

Cortical Bony Thickening of the Lateral Intercondylar Wall: The Functional Attachment of the Anterior Cruciate Ligament

et al. 2016

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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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“…Therefore, we must improve the operative methods for anatomical single bundle reconstruction. Several anatomical studies have reported that the femoral insertion for the ACL has an oval or semilunar shape [12,13] , and we have also realized that the quadrupled semitendinosus and gracilis tendons appear to be oval, rather than circular. Therefore, we have designed and developed an original rounded rectangle tendon diameter tester and dilator for the new anatomical single bundle ACL reconstruction.…”

Section: The Anatomical Double Bundle Acl Reconstruction Technique Wamentioning

confidence: 96%

Technique of anatomical single bundle ACL reconstruction with rounded rectangle femoral dilator

et al. 2016

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The Femoral Insertion of the Anterior Cruciate Ligament: Discrepancy Between Macroscopic and Histological Observations

Cited by 146 publications

References 39 publications

Cortical Bony Thickening of the Lateral Intercondylar Wall: The Functional Attachment of the Anterior Cruciate Ligament

Cortical Bony Thickening of the Lateral Intercondylar Wall: The Functional Attachment of the Anterior Cruciate Ligament

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

Technique of anatomical single bundle ACL reconstruction with rounded rectangle femoral dilator

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