Incidence of the Remnant Femoral Attachment of the Ruptured ACL

Wittstein, Jocelyn; Kaseta, Maria Kyriaki; Sullivan, Robert T.; Garrett, William E.

doi:10.1007/s11999-009-0805-y

Cited by 16 publications

(7 citation statements)

References 19 publications

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“…Soft tissue remnants of the ACL stumps, rupture pattern, and anatomical landmarks such as the lateral bifurcate and intercondylar ridges of the femur (present in 98% of cases) have been shown to be critical components for defining the native ACL anatomy. 8,9,20,[26][27][28] Recent publications have recommended single-bundle ACLR instead of a double-bundle ACLR in cases where the ACL insertion site is 14 mm in length. 19 Furthermore, the size of ACL insertion sites may influence the size of the graft and thus the graft choice, as certain grafts may limit the ability to restore the native insertion site size.…”

Section: Discussionmentioning

confidence: 99%

Size Variability of the Human Anterior Cruciate Ligament Insertion Sites

et al. 2010

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Section: Discussionmentioning

confidence: 99%

Size Variability of the Human Anterior Cruciate Ligament Insertion Sites

et al. 2010

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“…A graft-size-appropriate cannulated reamer was used to create the tibial tunnel. Using the anteromedial portal, the femoral tunnel was placed by positioning the guide (Retro-Drill, Arthrex, Naples, FL) near the center of the ACL footprint, as estimated visually by the surgeon (Kaseta 2008; Wittstein 2009). A guide-pin was placed from outside the joint through a small incision over the lateral femoral cortex just proximal to the lateral femoral condyle and anterior to the intermuscular septum.…”

Section: Methodsmentioning

confidence: 99%

The effect of femoral tunnel placement on ACL graft orientation and length during in vivo knee flexion

Abebe

Kim

Utturkar

et al. 2011

Journal of Biomechanics

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Anatomically placed grafts are believed to more closely restore the function of the ACL. This study measured the effect of femoral tunnel placement on graft orientation and length during weight-bearing flexion. Both knees of twelve patients where the graft was placed near the anteroproximal border of the ACL and ten where the graft was placed near the center of the ACL were imaged using MR. These images were used to create 3D models of the reconstructed and intact contralateral knees, including the attachment sites of the native ACL and graft. Next, patients were imaged using biplanar fluoroscopy while performing a quasi-static lunge. The models were registered to the fluoroscopic images to reproduce in vivo knee motion. From the relative motion of the attachment sites on the models, the length and orientation of the graft and native ACL were measured. Grafts placed anteroproximally on the femur were longer and more vertical than the native ACL in both the sagittal and coronal planes, while anatomically placed grafts more closely mimicked ACL motion. In full extension, the grafts placed anteroproximally were 12.3±5.2° (mean and 95%CI) more vertical than the native ACL in the sagittal plane, whereas the grafts placed anatomically were 2.9±3.7° less vertical. Grafts placed anteroproximally were up to 6±2mm longer than the native ACL, while the anatomically placed grafts were a maximum of 2±2mm longer. In conclusion, grafts placed anatomically more closely restored native ACL length and orientation. As a result, anatomic grafts are more likely to restore intact knee kinematics.

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“…Crain et al, and Lo et al observed 18 reattachments out of 48 cases and 67 reattachments out of 101 cases, respectively . In contrast, Murray et al and Wittstein et al reported that in all cases that the tibial ACL remnant was resorbed and a reattachment of the ACL remnants was not present in any of the cases. This difference in the incidence of reattachments may be explained by the difference in injury mechanism between the patients, which could result in a difference in tibial ACL remnant length and in turn in the chance to reattach.…”

Section: Discussionmentioning

confidence: 97%

Intrinsic healing response of the human anterior cruciate ligament: An histological study of reattached ACL remnants

Nguyen

Ramwadhdoebé

Hart

et al. 2013

Journal Orthopaedic Research

101

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A reattachment of the tibial remnant of the torn anterior cruciate ligament (ACL) to the posterior cruciate ligament is sometimes observed during surgery and apparently implies that the human ACL does have a healing response. The aim of this study was to investigate whether this reattachment tissue has similar histological characteristics of a healing response as the medial collateral ligament (MCL), which can heal spontaneously. Standard histology and immunostaining of a-smooth muscle actin and collagen type 3 was performed. The results shows that the reattached tissue has typical characteristics of a healing response: the reattached ACL remnant could not be released by forceful traction; microscopy showed that the collagen fibers of the reattached tissue were disorganized with no preferred direction; increased neovascularization; the presence of lipid vacuoles; the mean number of cells within the biopsy tissue was 631 AE 269 cells per mm 2 ; and 68 AE 20% was expressing a-SMA; semi-quantitative analysis of collagen type 3 expression showed that collagen type 3 had an high expression with an average score of 3. In conclusion, this study shows that the human proximal 1/3 ACL has an intrinsic healing response with typical histological characteristics similar to the MCL. ß

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Incidence of the Remnant Femoral Attachment of the Ruptured ACL

Cited by 16 publications

References 19 publications

Size Variability of the Human Anterior Cruciate Ligament Insertion Sites

Size Variability of the Human Anterior Cruciate Ligament Insertion Sites

The effect of femoral tunnel placement on ACL graft orientation and length during in vivo knee flexion

Intrinsic healing response of the human anterior cruciate ligament: An histological study of reattached ACL remnants

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