(Fig 2-B.26) Scar tissue Attachment to the Anatomical origin of the ACL

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★ Patterns of ACL Scarring:

1. End-to-End Scarring: The torn ends of the ACL heal by connecting each other.
   
2. Scarring to the PCL: The ACL forms scar tissue that attaches to the posterior cruciate ligament (PCL).
   
3. Scarring to the Roof of the Intercondylar Notch: The ACL scar tissue attaches to the upper area of the intercondylar notch
   
4. Scarring of the Distal Remnant to the Anatomic Origin: The lower part of the torn ACL attaches back to its original site.
   

★ General Observations on ACL Scarring:

• The scar tissue from the ACL most frequently attaches to the lateral side of the proximal PCL and the intercondylar notch. It is less common for the scar to attach back to the ACL's original attachment point.
• Among these patterns, scarring that reconnects the ACL to its original attachment point is rare but results in the most significant improvement, leading to reduced laxity (looseness) during clinical examinations.
  
• Even if the ACL forms a continuous structure through scarring, the healed ligament is usually functionally weaker than before the injury.
  

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