Abstract
BackgroundThis study compared the failure load of the femoral insertion site of the anterior cruciate ligament between different portions and knee flexion angles.MethodsIn total, 87 fresh-frozen, porcine knees were used in this study. Three knees were used for histological evaluation; the remaining 84 knees were randomly divided into 4 groups: anterior anteromedial bundle, posterior anteromedial bundle, anterior posterolateral bundle, and posterior posterolateral bundle groups (n=21 per group). The anterior cruciate ligament femoral insertion site was divided into these four areas and excised, leaving a 3-mm square attachment in the center of each bundle. Tibia-anterior cruciate ligament-femur complexes were placed in a material testing machine at 30°, 120°, and 150° of knee flexion (n=7), and the failure load for each portion was measured under anterior tibial loading (0.33 mm/s).ResultsHistological study showed that the anterior cruciate ligament femoral insertion site consisted of direct and indirect insertions. Comparison of the failure load between the knee flexion angles revealed that all the failure loads decreased with knee flexion; significant decreases were observed in the failure load between 30 and 150° knee flexion in the posterior anteromedial bundle and posterior posterolateral bundle groups. Comparison of the failure load according to different portions revealed a significant difference between the anteromedial and posterolateral bundle groups at 150° of knee flexion, but no significant difference among the groups at 30° of flexion.ConclusionsAlthough the failure load of the posterior portion decreased significantly in the knee flexion position, it (mainly consisting of indirect insertion) plays a significant role against anterior tibial load in the knee extension position; this appears to be related to the characteristics of the insertion site. Reflecting the complex structure and function of the ACL, this study showed that the failure load of the femoral insertion site varies with differences in positions and knee flexion angles.
Highlights
This study compared the failure load of the femoral insertion site of the anterior cruciate ligament between different portions and knee flexion angles
There was no significant difference across all the knee flexion angles in both the aAMB and a-posterolateral bundle (PLB) groups, which had direct insertions, Fig. 2 Testing apparatus and specimen
This study showed no significant differences in failure loads between the anterior portion and the posterior portion of the anterior cruciate ligament (ACL) femoral insertion site in 30 degrees of flexion
Summary
This study compared the failure load of the femoral insertion site of the anterior cruciate ligament between different portions and knee flexion angles. The anterior cruciate ligament (ACL) is the most commonly injured ligament within the knee joint during sports activities. The most frequent technical error is an anterior placement of the femoral tunnel [2]; another reason for the unsatisfactory results is that the geometric complexity of the ACL cannot be completely reproduced during surgical reconstruction [3]. Numerous biomechanical and anatomical studies have been conducted on ACL reconstruction to improve its results. The ACL fibers are aligned parallel to the intercondylar roof in the fully extended position; the posterior portion of the femoral attachment consists of fanlike extension fibers that appear to be thin and coarse compared to the midsubstance fibers [8]. The transition zone from the direct fibers to the bone had more interdigitations than that of the indirect insertion site; this may indicate the importance of direct insertion
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