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On the heterogeneity of the femoral enthesis of the human ACL: microscopic anatomy and clinical implications

Overview of attention for article published in Journal of Experimental Orthopaedics, July 2016
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Title
On the heterogeneity of the femoral enthesis of the human ACL: microscopic anatomy and clinical implications
Published in
Journal of Experimental Orthopaedics, July 2016
DOI 10.1186/s40634-016-0050-8
Pubmed ID
Authors

Mélanie L. Beaulieu, Grace E. Carey, Stephen H. Schlecht, Edward M. Wojtys, James A. Ashton-Miller

Abstract

Most ruptures of the native anterior cruciate ligament (ACL) and ACL graft occur at, or near, the femoral enthesis, with the posterolateral fibers of the native ligament being especially vulnerable during pivot landings. Characterizing the anatomy of the ACL femoral enthesis may help us explain injury patterns which, in turn, could help guide injury prevention efforts. It may also lead to improved anatomic reconstruction techniques given that the goal of such techniques is to replicate the knee's normal anatomy. Hence, the aim of this study was to investigate the microscopic anatomy of the ACL femoral enthesis and determine whether regional differences exist. Fifteen human ACL femoral entheses were histochemically processed and sectioned along the longitudinal axis of the ACL at 20, 40, 60, and 80 % of the width of the enthesis. Four thick sections (100 μm) per enthesis were prepared, stained, and digitized. From these sections, regional variations in the quantity of calcified and uncalcified fibrocartilage, the angle at which the ligament originates from the bone, and the shape profile of the tidemark were quantified. At least 33 % more calcified fibrocartilage and 143 % more uncalcified fibrocartilage were found in the antero-inferior region, which corresponds to the inferior margin of the origin of the anteromedial ACL fibers, than all other regions (Ps < 0.05). In addition, the anteromedial fibers of the ACL originated from the femur at an angle six times greater than did its posterolateral fibers (P = 0.032). Finally, average entheseal tidemark profiles correlated bilaterally (Pearson's r = 0.79; P = 0.036), the most common profile being convex with a single re-entrant. Systematic regional differences were found in fibrocartilage quantity and collagen fiber attachment angles. The marked differences may reflect differences in the loading history of the various regions of the ACL femoral enthesis. These differences, which could affect the potential for injury, should also be considered when developing new ACL reconstruction approaches.

Twitter Demographics

The data shown below were collected from the profiles of 2 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 26 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Poland 1 4%
Unknown 25 96%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 8 31%
Student > Bachelor 3 12%
Researcher 3 12%
Student > Master 3 12%
Student > Doctoral Student 2 8%
Other 3 12%
Unknown 4 15%
Readers by discipline Count As %
Medicine and Dentistry 9 35%
Engineering 7 27%
Materials Science 1 4%
Chemical Engineering 1 4%
Unknown 8 31%

Attention Score in Context

This research output has an Altmetric Attention Score of 2. 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 29 July 2016.
All research outputs
#4,031,725
of 8,154,593 outputs
Outputs from Journal of Experimental Orthopaedics
#10
of 27 outputs
Outputs of similar age
#127,455
of 257,935 outputs
Outputs of similar age from Journal of Experimental Orthopaedics
#2
of 3 outputs
Altmetric has tracked 8,154,593 research outputs across all sources so far. This one is in the 49th percentile – i.e., 49% of other outputs scored the same or lower than it.
So far Altmetric has tracked 27 research outputs from this source. They receive a mean Attention Score of 2.9. This one scored the same or higher as 17 of them.
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We're also able to compare this research output to 3 others from the same source and published within six weeks on either side of this one.