ANATOMY&BIOMECHANICS

Presented by: Inbar Evron University of Miami Department of Biomedical Engineering

Length of 38mm (25-41mm) Width of 10mm (7-12mm)

The ACL is made up of multiple collagen fiber bundles The major cell type is the fibroblast Type 1 collagen is the major constituent ( 7080% dry weight) Type 3 (8% dry weight) and type 4 (12% dry weight) are other major components Between 65 to 75% of a ligaments total weight is composed of water

COLLAGEN FIBERS

Cross linked character of collagen fibrils(150 to 250 nanometer in diameter ) Fibrils are grouped into fibers (1 to 20 um in diameter) A bundle of fibers is surrounded by an endotenon (endotendineum) Synovial membrane envelope encloses the ACL

Poor blood supply Blood supply from the middle genicular artery Vessels predominantly in the soft tissues (fat pad, synovial membrane) Bony attachments do not provide a significant source of blood to distal or proximal ligaments

ACL arises from the posteromedial corner of medial aspect of lateral femoral condyle in the intercondylar notch An attachment is actually an interdigitation of collagen fibers & rigid bone thru transitional zone of fibrocartilage and mineralized fibrocartilage

A wide area in front of and lateral to anterior tibial spine Some fibers attach to lower anterior surface of spine and anterior horn of lateral meniscus

The ACL consists of two bundles,an anteromedial (AM), and a posterolateral (PM) bundle

The anteromedial (AM) bundle is tight in flexion and the posterolateral (PM) bundle is tight in extension The AM is thought to be important as a restraint to anterior-posterior translation of the knee, while the PL is thought to be an important restraint to rotational moments about the knee.

Ultimate tensile load: 2160 157 N Stiffness: 242 28 N/mm passive knee extension produces forces along ACL only during last 10 degrees of knee extension

The posterolateral (PM) bundle of the ACL is tight in extension At 5 degrees of hyperextension, ACL forces range between 50 and 240 newtons Hyperextension of the knee develops much higher forces in ACL than in the PCL

The anteromedial (AP) bundle of the ACL is tight in flexion Movement from extension to 90 deg of flexion changes the position of the tibia relative to the femur differently for the medial and lateral compartment The muscles spanning the knee apply forces and moments to the joint

An increase in ACL strain produced by contraction of the quadriceps muscle group when the knee is between full extension and approximately 50 deg flexion Contarction of the quadriceps with the knee near extension produces substantial anterior tibial translations

Contraction of the hamstring muscles produces a posterior directed force that acts on the tibia throughout the range of knee flexion Movement of the knee from a flexed to an extended position , passively or through contraction of the leg muscles, produces an increase in ACL strain values. Active extension of knee between the limits of 50 and 110 degrees does not strain the ACL

Unsectioned ACL's in neutral rotation, application of 100 newtons of anterior force produces: - 2-5 mm of anterior translation at full extension - 5-8 mm of translation at 30 deg of flexion - as flexion angle increases further, anterior translation decreases Sectioning of ACL results in increased laxity at all flexion angles - 20-30 deg of flexion: - maximum anterior translation occurs w/ 100-newton anterior force ( 7-9 mm of increased translation is seen )

ACL is the predominant restraint to anterior tibial displacement ACL limits internal-external rotational movement ACL is a restraint to adduction and abduction at full extension

ACL is taut in full knee extension, and tends to externally rotate tibia Tension in ACL is least at 40 to 50 deg of knee flexion ACL guides the screw home mechanism near full extension Towards full extension the tibia& joint rotate externally

ACL does not remain an isometric (constant length) structure as the knee is flexed and extended Ligament increases in strain magnitude as the lower leg is passively extended, with the femur in a horizontal plane