The Fetal Anterior Cruciate Ligament: An Anatomic and Histologic Study

Ferretti, Mário; Levicoff, Eric A.; Macpherson, Trevor A.; Moreland, Morey S.; Cohen, Moisés; Fu, Freddie H.

doi:10.1016/j.arthro.2006.11.006

Cited by 160 publications

(105 citation statements)

References 16 publications

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“…In a histological study, Odensten and Gillquist (12) found no evidence of distinct bundles in the ACL. The distinction between the 2 bundles of the fetal ACL was observed clearly in the transverse and sagittal histologic sections, with a well-defined septum of vascularized connective tissue dividing the AM and PL bundles (23). However, we found no conspicuous septum dividing the AM and PL bundles in the transverse histologic sections.…”

Section: Discussionmentioning

confidence: 43%

Regional fibrocartilage variations in human anterior cruciate ligament tibial insertion: a histological three-dimensional reconstruction

Dai

Guo

Yang

et al. 2014

Connective Tissue Research

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We studied anterior cruciate ligament (ACL) tibial insertion architecture in humans and investigated regional differences that could suggest unequal force transmission from ligament to bone. Materials and methods: ACL tibial insertions were processed histologically. With Photoshop software, digital images taken from the histological slides were collaged, contour lines were drawn, and different gray values were filled based on the structure. The data were exported to Amira software for three-dimensional reconstruction. Results: The uncalcified fibrocartilage (UF) layer was divided into three regions: lateral, medial and posterior according to the architecture. The UF zone was significantly thicker laterally than medially or posteriorly (p50.05). Similarly, the calcified fibrocartilage (CF) thickness was significantly greater in the lateral part of the enthesis compared to the medial and posterior parts (p50.05). Conclusions:The UF quantity (more UF laterally) corresponding to the CF quantity (more CF laterally) at the ACL tibial insertion provides further evidence suggesting that the load transferred from the ACL to the tibia was greater laterally than medially and posteriorly.

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Section: Discussionmentioning

confidence: 43%

Regional fibrocartilage variations in human anterior cruciate ligament tibial insertion: a histological three-dimensional reconstruction

Dai

Guo

Yang

et al. 2014

Connective Tissue Research

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“…35 This has been confirmed by anatomic studies of fetal specimens. 36 The AM and PL bundles are named according to their tibial insertions. On the femur, the AM bundle lies more superiorly and anteriorly, which corresponds to a high and deep location in the notch when viewed arthroscopically with the knee at 90…”

Section: Discussionmentioning

confidence: 99%

TriLink: Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

Yasen

Logan

Smith

et al. 2014

Arthroscopy Techniques

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Cadaveric and clinical biomechanical studies show improved kinematic restoration using double-bundle anterior cruciate ligament (ACL) reconstruction techniques. These have been criticized in the past for being technically challenging. We present a novel 3-socket approach for anatomic "all-inside" double-bundle reconstruction using a single hamstring tendon fashioned to create a trifurcate graft: the TriLink technique. The semitendinosus alone is harvested, quadrupled, and attached to 3 suspensory fixation devices in a Y-shaped configuration, creating a 4-stranded tibial limb and 2 double-stranded femoral limbs. A medial viewing/lateral working arthroscopic approach is adopted using specifically designed instrumentation. Anatomic placement of the 2 femoral tunnels is performed by a validated direct measurement technique. A single mid-bundle position is used on the tibia. Both femoral and tibial sockets are created in a retrograde manner using outside-to-in drilling. This is a simplified operative technique for anatomic double-bundle ACL reconstruction that maximizes bone preservation. The TriLink construct replicates the 2 bundles of the ACL, conferring native functional anisometry and improving femoral footprint coverage while avoiding the complexities and pitfalls of doubleetibial tunnel techniques. Preservation of the gracilis reduces the morbidity of hamstring harvest and allows greater flexibility in graft choice in cases requiring multiligament reconstruction.

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“…Knee stability and cartilage incident forces are displayed in distinctive ways related to anatomical and nonanatomical ACL reconstruction. As already stated, given the better understanding of ACL anatomy, there has been a transition from the so-called isometric reconstruction to anatomic reconstruction of the ACL [4,5]. Allegedly, some studies pointed out that anatomical tunnel placement results in superior biological healing, biomechanical properties, knee stability, and even a protective cartilage effect, as compared with a nonanatomic reconstruction [45][46][47][48][49].…”

Section: Mechanical Stimulimentioning

confidence: 99%

“…ACLR is a common orthopedic procedure. There have been many advances in ACLR techniques in the last few years, in part because of a better understanding of the ligament anatomy and a transition from the so-called isometric reconstruction to anatomic reconstruction of the ACL [4,5]. Despite these advances, ACLR is not a universally successful procedure and has actual failure rates around 8 % [5].…”

Section: Introductionmentioning

confidence: 99%

Updates in biological therapies for knee injuries: anterior cruciate ligament

Franciozi

Ingham

Gracitelli

et al. 2014

Curr Rev Musculoskelet Med

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There have been many advances in anterior cruciate ligament reconstruction (ACLR) techniques incorporating biological treatment. The aim of this review is to discuss the recent contributions that may enlighten our understanding of biological therapies for anterior cruciate ligament (ACL) injuries and improve management decisions involving these enhancement options. Three main biological procedures will be analyzed: bio-enhanced ACL repair, bio-enhanced ACLR scrutinized under the four basic principles of tissue engineering (scaffolds, cell sources, growth factors/cytokines including platelet-rich plasma, and mechanical stimuli), and remnant-preserving ACLR. There is controversial information regarding remnant-preserving ACLR, since different procedures are grouped under the same designation. A new definition for remnant-preserving ACLR surgery is proposed, dividing it into its three major procedures (selective bundle augmentation, augmentation, and nonfunctional remnant preservation); also, an ACL lesion pattern classification and a treatment algorithm, which will hopefully standardize these terms and procedures for future studies, are presented.

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The Fetal Anterior Cruciate Ligament: An Anatomic and Histologic Study

Cited by 160 publications

References 16 publications

Regional fibrocartilage variations in human anterior cruciate ligament tibial insertion: a histological three-dimensional reconstruction

Regional fibrocartilage variations in human anterior cruciate ligament tibial insertion: a histological three-dimensional reconstruction

TriLink: Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

Updates in biological therapies for knee injuries: anterior cruciate ligament

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