| Title |
Direct versus indirect ACL femoral attachment fibres and their implications on ACL graft placement
|
|---|---|
| Published in |
Knee Surgery, Sports Traumatology, Arthroscopy, June 2016
|
| DOI | 10.1007/s00167-016-4188-9 |
| Pubmed ID | |
| Authors |
Samuel G. Moulton, Brett D. Steineman, Tammy L. Haut Donahue, Cristián A. Fontboté, Tyler R. Cram, Robert F. LaPrade |
| Abstract |
To further elucidate the direct and indirect fibre insertion morphology within the human ACL femoral attachment using scanning electron microscopy and determine where in the footprint each fibre type predominates. The hypothesis was that direct fibre attachment would be found centrally in the insertion site, while indirect fibre attachment would be found posteriorly adjacent to the posterior articular cartilage. Ten cadaveric knees were dissected to preserve and isolate the entirety of the femoral insertion of the ACL. Specimens were then prepared and evaluated with scanning electron microscopy to determine insertional fibre morphology and location. The entirety of the fan-like projection of the ACL attachment site lay posterior to the lateral intercondylar ridge. In all specimens, a four-phase architecture, consistent with previous descriptions of direct fibres, was found in the centre of the femoral attachment site. The posterior margin of the ACL attachment attached directly adjacent to the posterior articular cartilage with some fibres coursing into it. The posterior portion of the ACL insertion had a two-phase insertion, consistent with previous descriptions of indirect fibres. The transition from the ligament fibres to bone had less interdigitations, and the interdigitations were significantly smaller (p < 0.001) compared to the transition in the direct fibre area. The interdigitations of the direct fibres were 387 ± 81 μm (range 282-515 μm) wide, while the interdigitations of indirect fibres measured 228 ± 75 μm (range 89-331 μm). The centre of the ACL femoral attachment consisted of a direct fibre structure, while the posterior portion had an indirect fibre structure. These results support previous animal studies reporting that the centre of the ACL femoral insertion was comprised of the strongest reported fibre type. Clinically, the femoral ACL reconstruction tunnel should be oriented to cover the entirety of the central direct ACL fibres and may need to be customized based on graft type and the fixation device used during surgery. |
X Demographics
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Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 45 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 45 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 9 | 20% |
| Student > Ph. D. Student | 7 | 16% |
| Student > Master | 5 | 11% |
| Student > Postgraduate | 4 | 9% |
| Other | 3 | 7% |
| Other | 7 | 16% |
| Unknown | 10 | 22% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 18 | 40% |
| Engineering | 5 | 11% |
| Nursing and Health Professions | 4 | 9% |
| Social Sciences | 1 | 2% |
| Unknown | 17 | 38% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 12 March 2017.
All research outputs
#15,450,375
of 22,959,818 outputs
Outputs from Knee Surgery, Sports Traumatology, Arthroscopy
#1,803
of 2,669 outputs
Outputs of similar age
#223,345
of 353,270 outputs
Outputs of similar age from Knee Surgery, Sports Traumatology, Arthroscopy
#26
of 44 outputs
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