Posterior fan-like extension of the anterior cruciate ligament femoral insertion increases ligament failure strength

Ryo Kanto; Michael P. Smolinski; Aly M. Fayed; Monica A. Linde; Volker Musahl; Freddie H. Fu; Patrick Smolinski

doi:10.1016/j.jisako.2025.100939

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Posterior fan-like extension of the anterior cruciate ligament femoral insertion increases ligament failure strength

Journal article

Open access

Peer reviewed

Posterior fan-like extension of the anterior cruciate ligament femoral insertion increases ligament failure strength

Ryo Kanto, Michael P. Smolinski, Aly M. Fayed, Monica A. Linde, Volker Musahl, Freddie H. Fu and Patrick Smolinski

Journal of ISAKOS, Vol.14, pp.100939-100939

10/01/2025

DOI: 10.1016/j.jisako.2025.100939

PMID: 40783135

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Abstract

The purpose of this study was to examine the role of the posterior fan-like extension (PFLE) region of the anterior cruciate ligament (ACL) on ligament failure load. It was hypothesized that transection of the PFLE region would reduce the ACL load-carrying capacity. With institutional approval, fifteen fresh-frozen human cadaveric knees were divided into two age-matched groups: intact ACL femoral insertion (ACL intact group, n = 8) and the cut ACL fan-like extension (PFLE-cut group, n = 7). In the PFLE-cut group, the border between the mid-substance insertion and the PFLE was identified at 90° of knee flexion, and the border was cut. All specimens were dissected down to the ACL and placed in an axial testing machine at 15° of flexion, and anterior tibial loading was applied until ACL failure. The failure (peak) load of the ACL intact group was 910.1 ± 473.3 N, which was significantly greater (P < 0.05) than the failure load of the PFLE-cut group (409.5 ± 219.7 N). The displacement at the failure load of the ACL intact group was 21.7 ± 5.5 mm, which was significantly greater (P < 0.05) than the 14.5 ± 4.9 mm failure load displacement of the PFLE-cut group. Transection of the PFLE region of the ACL femoral footprint significantly reduced the failure load of the ligament under anterior tibial loading at 15° of flexion. The morphology of the ACL at the femoral insertion significantly affects the failure strength of the ligament. If ACL reconstruction grafts could be constructed to more closely mimic this geometry, they could potentially have increased failure strengths and reduce failure rates. Not applicable.

ACL failure load

ACL femoral insertion

Knee biomechanics

Posterior fan-like extension region

Details

Title: Subtitle: Posterior fan-like extension of the anterior cruciate ligament femoral insertion increases ligament failure strength
Creators: Ryo Kanto - University of Pittsburgh
Michael P. Smolinski - University of Pittsburgh
Aly M. Fayed - University of Pittsburgh
Monica A. Linde - University of Pittsburgh
Volker Musahl - University of Pittsburgh
Freddie H. Fu - University of Pittsburgh
Patrick Smolinski - University of Pittsburgh
Resource Type: Journal article
Publication Details: Journal of ISAKOS, Vol.14, pp.100939-100939
DOI: 10.1016/j.jisako.2025.100939
PMID: 40783135
NLM abbreviation: J ISAKOS
ISSN: 2059-7754
eISSN: 2059-7762
Publisher: Elsevier Inc; AMSTERDAM
Language: English
Date published: 10/01/2025
Academic Unit: Orthopedics and Rehabilitation
Record Identifier: 9984949201402771

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