ArticleJournal of experimental orthopaedics2016
On the heterogeneity of the femoral enthesis of the human ACL: microscopic anatomy and clinical implications.
Article in Journal of experimental orthopaedics, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
15 citing papers in PubMed, 52 citations in OpenAlex.
- Effect of Internal Tibial Torque on ACL Tear at the Femoral Enthesis.Annals of biomedical engineering · 2026Article
- Interobserver variability in assessing anterior cruciate ligament anatomy: comparing gross and microanatomical observations.Surgical and radiologic anatomy : SRA · 2026Article
- Dynamic Deformation Behavior of the Porcine Anterior Cruciate Ligament Enthesis Under Anterior Tibial Loading.Annals of biomedical engineering · 2025Article
- Mineralized tissue loss at the femoral ACL enthesis in young male ACL-injured patients.Journal of experimental orthopaedics · 2025Article
- Anatomical Tissue Engineering of the Anterior Cruciate Ligament Entheses.International journal of molecular sciences · 2023Review
- Co-Culture of Mesenchymal Stem Cells and Ligamentocytes on Triphasic Embroidered Poly(L-lactide-co-ε-caprolactone) and Polylactic Acid Scaffolds for Anterior Cruciate Ligament Enthesis Tissue Engineering.International journal of molecular sciences · 2023Article
- ACL microtrauma: healing through nutrition, modified sports training, and increased recovery time.Journal of experimental orthopaedics · 2022Review
- On the management of maternal pushing during the second stage of labor: a biomechanical study considering passive tissue fatigue damage accumulation.American journal of obstetrics and gynecology · 2022Article
- Anatomy and histomorphology of the flexor digitorum profundus enthesis: functional implications for tissue engineering and surgery.BMC musculoskeletal disorders · 2021Article
- Femoral Intercondylar Notch: Gross Anatomy and Histology of the Connective Tissue Lining of its Roof: A Pilot Study.Surgical and radiologic anatomy : SRA · 2021Observational
- Osteoprotegerin/bone morphogenetic protein 2 combining with collagen sponges on tendon-bone healing in rabbits.Journal of bone and mineral metabolism · 2020Article
- Morphology of Mouse Anterior Cruciate Ligament-Complex Changes Following Exercise During Pubertal Growth.Journal of orthopaedic research : official publication of the Orthopaedic Research Society · 2019Article
- Mechanical and Microstructural Properties of Pediatric Anterior Cruciate Ligaments and Autograft Tendons Used for Reconstruction.Orthopaedic journal of sports medicine · 2019Article
- Femoral entheseal shape and attachment angle as potential risk factors for anterior cruciate ligament injury.Journal of the mechanical behavior of biomedical materials · 2018Article
- New perspectives on ACL injury: On the role of repetitive sub-maximal knee loading in causing ACL fatigue failure.Journal of orthopaedic research : official publication of the Orthopaedic Research Society · 2016Review
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundMost 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.
methodsFifteen 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.
resultsAt 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.
conclusionsSystematic 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.
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