Development of the ACL

The ACL form from a bundle of specialized cells called fibroblasts. It differentiates and matures into the fibrous tissue that makes up the ligament. ACL begins to start as early as 8 weeks of gestation. And then it continues to develop throughout the pregnancy. The ligament becomes more significant and more elastic. As the child grows, allow for proper knee function. It continues during activities such as running and jumping.

Femoral Attachment

The Tibial Attachment
Spatial Orientation

The ACL has a specific spatial orientation essential for stabilizing the knee joint. It can cause the ligament to become stretched and torn from its attachment sites. It can also detach from its attachment sites. And it was altering its spatial orientation. In some cases, surgery may be necessary. Through surgery, it restores the proper spatial orientation of the ACL.

Micro Anatomy


The ACL consists of muscular fibrous tissue that composes of collagen fibres. Collagen fibres are arranged in a specific pattern. It is called a crimp pattern, which allows the ligament to stretch and recoil during movement. The ligament is rich in blood vessels and nerve fibres. It helps to provide nutrition and sensation to the ligaments. It can lead to weakening or tearing, resulting in knee instability.

The ACL comprises dense fibrous tissue and long, parallel collagen fibres. These collagen fibres are the primary structural component of the ACL and provide the ligament with strength and toughness. The ACL also contains a small amount of elastin, a protein that gives elasticity to the ligament and helps it return to its original shape after being stretched.

In addition to collagen and elastin, the ACL contains several other biochemical components, including:

  • Proteoglycans: These large, complex molecules are a significant component of the extracellular matrix and play a crucial role in maintaining the hydration and elasticity of the ACL.
  • Glycoproteins: These proteins are involved in cell-cell and cell-matrix interactions and regulate cell behaviour and tissue repair.
  • Enzymes: The ACL contains several enzymes, including matrix metalloproteinases (MMPs), which play a role in the breakdown and repair of the extracellular matrix.
  • Growth factors: The ACL contains several growth factors, including transforming growth factor-beta (TGF-beta), which regulates cell growth and tissue repair.

The structural properties

It refers to the physical characteristics of the ligament. It also determines its strength, elasticity, and resistance to tearing. It provides stability and support to the knee joint during movement. It can affect its properties and lead to instability. It reduces the difficulty with activities that need knee stability.

The ACL is a complex structure made up of several anatomical components, including:

  • Bundle origin: The ACL originates from the intercondylar area of the femur (thigh bone), specifically from the anteromedial aspect of the lateral femoral condyle.
  • Bundle insertion: The ACL inserts into the anterior aspect of the tibia (shin bone) just below the tibial plateau.
  • Ligament fibres: The ACL consists of dense fibrous tissue of long, parallel collagen fibres. These fibres are arranged in two distinct functional bundles, the anteromedial and posterolateral, which work together to control rotational and translational movements of the knee.
  • Synovial membrane: The ACL is surrounded by a synovial membrane, which produces synovial fluid that lubricates and nourishes the ligament.
  • Nerve supply: The ACL is supplied by the femoral nerve, which provides sensation and helps control muscle contractions in the surrounding muscles.
  • Blood supply: The ACL receives its blood supply from the geniculate branches of the popliteal artery. This blood supply is essential for maintaining the integrity and healing of the ligament after injury.

The mechanical properties

Mechanical properties refer to how a material responds to external loads and forces. The mechanical properties of the ACL are an essential aspect of its function and can be described in terms of several parameters, including:

  • Tensile strength: The maximum force the ACL can withstand before it fails. The tensile strength of the ACL is influenced by factors such as the arrangement of collagen fibres, the presence of microcracks, and the age of the individual.
  • Elasticity: This is the ability of the ACL to stretch and then return to its original shape. The presence of elastin and the collagen fibres’ arrangement influence the ACL’s elasticity.
  • Stiffness: This is the resistance of the ACL to deformation when subjected to a load. The stiffness of the ACL is influenced by factors such as its cross-sectional area, length, and arrangement of collagen fibres.
  • Damping: This is the ability of the ACL to absorb and dissipate energy when subjected to a load. The presence of proteoglycans and a synovial fluid’s viscosity influences the ACL’s damping.

ACL Fibril Arrangement

It refers to the specific organization of the collagen fibres. It makes up that ligament. It also composes of type I collagen fibres. It arranges in a particular pattern known as a “crimped” pattern. Injuries to the ACL can weaken or tear the ligaments, resulting in knee instability. And It also reduces the difficulty with activities requiring knee stability.

Effect of Mechanical Unloading on Histologic Changes

It refers to a reduction or absence of the standard mechanical forces acting on a tissue. In the case of the ACL, It can occur due to conditions such as immobilization or reduced activity levels. Reduced nerve activity may result in less oxygen and nutrients reaching the ligament. It will also happen when reduced blood flow.

Properties of Grafts

grafts can use to replace the ACL. These properties are essential for the surgical procedure’s success. And crucial for the knee’s long-term function. 
  • Autografts are considered the gold standard for ACL reconstruction because they have the best clinical outcomes and low complication rates. 
  • Synthetic grafts have the advantage of being available. Still, they may have a higher risk of failure and mechanical properties that do not match the native ACL.

The effects of muscle stabilization

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