Morphological and Histological Changes in the Human Anterior Cruciate Ligament after Rupture

Isr Med Assoc J. 2021 Jan;23(1):33-37.


Background: Injuries to the anterior cruciate ligament (ACL) are common and complete tears often fail to heal. ACL reconstruction is considered the surgical gold standard of care for ACL injuries in young active patients.

Objectives: To determine the corresponding morphological and histological features of the torn ACL in different time periods after injury.

Methods: The study included 28 remnant specimens of torn ACLs from patients who had ACL reconstruction surgery of the knee. The remnant pathology was evaluated by its morphology during arthroscopy and by histopathologic measurements.

Results: At surgery there were three progressive and distinct morphological tear patterns. The first pattern was noticed within the first 3 months from injury and showed no scar tissue. The second pattern appeared later and was characterized by the appearance of scar tissue with adhesion to the femoral wall. The third pattern was characterized by adhesion of the ACL remnant to the posterior cruciate ligament. The histological changes of the first morphological pattern showed abundance of blood vessels and lymphocytes at the torn femoral end with few irregular collagen fibers. The second and third tear patterns showed decrement in the number of blood vessels and lymphocytes with longitudinally oriented collagen fibers.

Conclusions: The morphological features of the ACL remnant in the first 3 months after injury showed no scar tissue and its histological features had the characteristics of a reparative phase. This phase was followed by a prolonged remodeling phase that ended with attachment of the remnant to the posterior cruciate ligament.

MeSH terms

  • Adult
  • Anterior Cruciate Ligament Injuries / surgery*
  • Anterior Cruciate Ligament Reconstruction* / adverse effects
  • Anterior Cruciate Ligament Reconstruction* / methods
  • Arthroscopy / methods
  • Cicatrix* / diagnostic imaging
  • Cicatrix* / etiology
  • Female
  • Granulation Tissue / blood supply
  • Granulation Tissue / pathology
  • Humans
  • Knee Joint* / blood supply
  • Knee Joint* / diagnostic imaging
  • Knee Joint* / pathology
  • Long Term Adverse Effects* / diagnostic imaging
  • Long Term Adverse Effects* / etiology
  • Male
  • Outcome Assessment, Health Care
  • Postoperative Period
  • Time Factors
  • Tissue Adhesions* / diagnostic imaging
  • Tissue Adhesions* / etiology