The Femoral Posterior Fan-like Extension of the ACL Insertion Increases the Failure Load

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2019 Oct 24

PMID 31642946

Citations 4

Authors

Soheil Sabzevari

Humza Shaikh

Brandon Marshall

Junjun Zhu

Monica A Linde

Patrick Smolinski

Freddie H Fu

Affiliations

Soon will be listed here.

Abstract

Purpose: To examine the role of the posterior fan-like extension of the ACL's femoral footprint on the ACL failure load.

Methods: Sixteen (n = 16) fresh frozen, mature porcine knees were used in this study and randomized into two groups (n = 8): intact femoral ACL insertion (ACL intact group) and cut posterior fan-like extension of the ACL (ACL cut group). In the ACL cut group, flexing the knees to 90°, created a folded border between the posterior fan-like extension and the midsubstance insertion of the femoral ACL footprint and the posterior fan-like extension was dissected and both areas were measured. Specimens were placed in a testing machine at 30° of flexion and subjected to anterior tibial loading (60 mm/min) until ACL failure.

Results: The intact ACL group had a femoral insertion area of 182.1 ± 17.1 mm. In the ACL cut group, the midsubstance insertion area was 113.3 ± 16.6 mm, and the cut posterior fan-like extension portion area was 67.1 ± 8.3 mm. The failure load of the ACL intact group was 3599 ± 457 N and was significantly higher (p < 0.001) than the failure load of the ACL cut group 392 ± 83 N.

Conclusion: Transection of the posterior fan-like extension of the ACL femoral footprint has a significant effect on the failure load of the ligament during anterior loading at full extension. Regarding clinical relevance, this study suggests the importance of the posterior fan-like extension of the ACL footprint which potentially may be retained with remnant preservation during ACL reconstruction. Femoral insertion remnant preservation may allow incorporation of the fan-like structure into the graft increasing graft strength.

Citing Articles

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The morphology of the femoral footprint of the anterior cruciate ligament changes with aging from a large semicircular shape to a small flat ribbon-like shape.

Morales-Avalos R, Perelli S, Vilchez-Cavazos F, Castillo-Escobedo T, Pena-Martinez V, Elizondo-Omana R Knee Surg Sports Traumatol Arthrosc. 2022; 30(10):3402-3413.

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Failure load of the femoral insertion site of the anterior cruciate ligament in a porcine model: comparison of different portions and knee flexion angles.

Yamauchi S, Ishibashi K, Sasaki E, Sasaki S, Kimura Y, Ishibashi Y J Orthop Surg Res. 2021; 16(1):526.

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Remnant preserving ACL reconstruction with a functional remnant is related to improved laxity but not to improved clinical outcomes in comparison to a nonfunctional remnant.

Franciozi C, Minami F, Ambra L, Ferreira Galvao P, Schumacher F, Kubota M Knee Surg Sports Traumatol Arthrosc. 2021; 30(5):1543-1551.

PMID: 33893826 DOI: 10.1007/s00167-021-06572-1.

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