Histological features of the ACL remnant in partial tears

Knee. 2014 Dec;21(6):1009-13. doi: 10.1016/j.knee.2014.07.020. Epub 2014 Jul 25.


Background: The aim of this study was to investigate the histological features of the remaining fibers bridging the femur and tibia in partial ACL tears.

Methods: Twenty-six ACL remnants were harvested from patients who had arthroscopic criteria concordant with a partial tear. Histological analysis includes cellularity, blood vessel density evaluation and characterization of the femoral bony insertion morphology. Immunohistochemical studies were carried out to determine cells positive for α-smooth actin and for mechanoreceptor detection.

Results: In these samples, a normal femoral insertion of the remnant was present in 22.7% of the cases. In 54% of the samples, substantial areas of hypercellularity were observed. Myofibroblasts were the predominant cell type and numerous cells positive for α-smooth actin were detected at immunostaining. Blood vessel density was increased in hypercellularity areas and in the synovial sheet. Free nerve endings and few Golgi or Ruffini corpuscles were detected in 41% of the specimens. The cellularity was correlated to the time between injury to surgery (p=0.001).

Conclusion: Competent histological structures including a well-vascularized synovial sheet, numerous fibroblasts and myofibroblasts and mechanoreceptors were found in ACL remnants. These histological findings bring additional knowledge towards the preservation of the ACL remnant in partial tears when ACL reconstruction or augmentation is considered.

Clinical relevance: Descriptive laboratory study.

Keywords: ACL biology; ACL histology; Anterior cruciate ligament; Graft healing; Partial ACL tears.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament / pathology
  • Anterior Cruciate Ligament Injuries*
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Arthroscopy
  • Female
  • Femur / pathology*
  • Femur / surgery
  • Humans
  • Immunohistochemistry
  • Male
  • Middle Aged
  • Prospective Studies
  • Tibia / pathology*
  • Tibia / surgery
  • Wound Healing / physiology*
  • Young Adult