The development of the anterior cruciate ligament in the paediatric population

Lima, Fernando Martins de; Debieux, Pedro; Astur, Diego Costa; Luzo, Marcus Vinicius Malheiro; Cohen, Moisés; Cardoso, Fabiano Nassar; Aihara, André Yui; Grimberg, Alexandre; Fernandes, Ana

doi:10.1007/s00167-019-05349-x

Cited by 15 publications

(26 citation statements)

References 33 publications

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“…Our findings regarding the growth of the ACL suggest that there are age-specific changes in the geometric proportions of the tissue throughout skeletal growth in the pig model, and that the growth of the ACL does not parallel growth in the other tissues. Similarly, previous studies have shown that the CSA of the human ACL increases in size up to 10–12 years of age but halts in growth prior to the end of overall skeletal growth [8, 31]. Additional studies comparing the growth of the human ACL to muscles surrounding the knee have shown more rapid growth in the ACL halting prior to the end of muscle growth [32].…”

Section: Discussionmentioning

confidence: 72%

Tissue-specific changes in size and shape of the ligaments and tendons of the porcine knee during post-natal growth

et al. 2019

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Prior studies have analyzed growth of musculoskeletal tissues between species or across body segments; however, little research has assessed the differences in similar tissues within a single joint. Here we studied changes in the length and cross-sectional area of four ligaments and tendons, (anterior cruciate ligament, patellar tendon, medial collateral ligament, lateral collateral ligament) in the tibiofemoral joint of female Yorkshire pigs through high-field magnetic resonance imaging throughout growth. Tissue lengths increased by 4- to 5-fold from birth to late adolescence across the tissues while tissue cross-sectional area increased by 10–20-fold. The anterior cruciate ligament and lateral collateral ligament showed allometric growth favoring change in length over change in cross-sectional area while the patellar tendon and medial collateral ligament grow in an isometric manner. Additionally, changes in the length and cross-sectional area of the anterior cruciate ligament did not increase as much as in the other ligaments and tendon of interest. Overall, these findings suggest that musculoskeletal soft tissue morphometry can vary within tissues of similar structure and within a single joint during post-natal growth.

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Section: Discussionmentioning

confidence: 72%

Tissue-specific changes in size and shape of the ligaments and tendons of the porcine knee during post-natal growth

et al. 2019

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“…31; 32 The female porcine ACL increases in length, CSA, and angular orientation throughout skeletal growth 22; 23 , similar to humans. 5–8; 33 These studies also revealed age-specific differences in growth and function of the AM and PL bundles. 23 However, these findings leave open the question of whether functional maturation of the ACL and its bundles is sex-specific.…”

Section: Introductionmentioning

confidence: 78%

“…The ACL is similar in size between males and females during childhood, but becomes larger in length and cross-sectional area (CSA) in males after the onset of adolescence. [5][6][7][8] Additionally, anterior-posterior (AP) knee laxity decreases throughout skeletal growth with similar values between males and females during childhood. [9][10][11] During adolescence [9][10][11] and adulthood, 12 AP knee laxity appears greater in females than males.…”

Section: Introductionmentioning

confidence: 99%

Sex-Specific Function and Morphology of the Anterior Cruciate Ligament During Skeletal Growth in a Porcine Model

Howe

Cone

Piedrahita

et al. 2021

Preprint

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Pediatric anterior cruciate ligament (ACL) injuries are on the rise, and females experience higher ACL injury risk than males during adolescence. Studies in skeletally immature patients indicate differences in ACL size and joint laxity between males and females after the onset of adolescence. However, functional data regarding the ACL and its anteromedial and posterolateral bundles in the pediatric population remain rare. Therefore, this study uses a porcine model to investigate the sex-specific morphology and function of the ACL and its bundles throughout skeletal growth. Hind limbs from male and female Yorkshire pigs aged early youth to late adolescence were imaged using magnetic resonance imaging to measure the size and orientation of the ACL and its bundles, then biomechanically tested under anterior-posterior drawer using a robotic testing system. Joint laxity decreased (p<0.001) while joint stiffness increased (p<0.001) throughout skeletal growth in both sexes. The ACL was the primary stabilizer against anterior tibial loading in all specimens, while the functional role of the anteromedial bundle increased with age (p<0.001), with an earlier shift in males. ACL and posterolateral bundle cross-sectional area and ACL and anteromedial bundle length were larger in males than females during adolescence (p<0.01 for all), while ACL and bundle sagittal angle remained similar between sexes. Additionally, in situ ACL stiffness correlated with cross-sectional area across skeletal growth (r2=0.75, p<0.001 in males and r2=0.64, p<0.001 in females), but not within age groups. This study has implications for age and sex-specific surgical intervention strategies and suggests the need for human studies.

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“…We do know that the ACL appears to sustain pronounced growth up to the age of 10 to 12 years, after which the ACL surface area and volume stabilize. 23,40 We do not know, however, how catabolic mechanisms might affect the ACL and its development or where the threshold between anabolic and catabolic factors lies. As with other tissues, 27,34 significant catabolic processes most likely start to occur when the rate of degradation exceeds the rate of synthesis, but these processes are unknown in the ACL.…”

Section: Discussionmentioning

confidence: 99%

The Anterior Cruciate Ligament Can Become Hypertrophied in Response to Mechanical Loading: A Magnetic Resonance Imaging Study in Elite Athletes

et al. 2021

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Background: Evidence, mainly from animal models, suggests that exercise during periods of pubertal growth can produce a hypertrophied anterior cruciate ligament (ACL) and improve its mechanical properties. In humans, the only evidence of ACL hypertrophy comes from a small cross-sectional study of elite weight lifters and control participants; that study had methodological weaknesses and, thus, more evidence is needed. Purpose: To investigate bilateral differences in the ACL cross-sectional area (CSA) for evidence of unilateral hypertrophy in athletes who have habitually loaded 1 leg more than the other. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We recruited 52 figure skaters and springboard divers (46 female and 6 male; mean age, 20.2 ± 2.7 years) because the former always land/jump on the same leg while the latter always drive the same leg into the board during their hurdle approach. Sport training for all participants began before puberty and continued throughout as well as after. Using oblique axial– and oblique sagittal–plane magnetic resonance imaging, we measured the ACL CSA and the anteroposterior diameter of the patellar tendon, respectively. In addition, isometric and isokinetic knee extensor and flexor peak torques were acquired using a dynamometer. Bilateral differences in the ACL CSA, patellar tendon diameter, and knee muscle strength were evaluated via 2-sided paired-samples t tests. Correlations between the bilateral difference in the ACL CSA and age of training onset as well as between the bilateral difference in the ACL CSA and years of training were also examined. Results: A significantly larger ACL CSA (mean difference, 4.9% ± 14.0%; P = .041), as well as patellar tendon diameter (mean difference, 4.7% ± 9.4%; P = .002), was found in the landing/drive leg than in the contralateral leg. The bilateral difference in the ACL CSA, however, was not associated with the age of training onset or years of training. Last, the isometric knee flexor peak torque was significantly greater in the landing/drive leg than the contralateral leg (mean difference, 14.5% ± 33.8%; P = .019). Conclusion: Athletes who habitually loaded 1 leg more than the other before, during, and after puberty exhibited significant unilateral ACL hypertrophy. This study suggests that the ACL may be able to be “trained” in athletes. If done correctly, it could help lower the risk for ACL injuries.

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The development of the anterior cruciate ligament in the paediatric population

Cited by 15 publications

References 33 publications

Tissue-specific changes in size and shape of the ligaments and tendons of the porcine knee during post-natal growth

Tissue-specific changes in size and shape of the ligaments and tendons of the porcine knee during post-natal growth

Sex-Specific Function and Morphology of the Anterior Cruciate Ligament During Skeletal Growth in a Porcine Model

The Anterior Cruciate Ligament Can Become Hypertrophied in Response to Mechanical Loading: A Magnetic Resonance Imaging Study in Elite Athletes

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