Ligaments and tendons are similar in composition but differ in proportion and arrangement. Tendons are being used as grafts
for the ACL reconstruction. Their microscopic structure has not been sufficiently studied and compared to the native ACL.
A null hypothesis was declared stating that the anterior cruciate ligament should be histological, morphologically and functionally
different from the tendon grafts used for ACL reconstruction. We investigated similarities and differences of the structure
of ACL and tendons used as a graft tissue for ACL reconstruction. In this study, standardized samples of quadriceps, hamstrings
(semitendinosus and gracilis) and patellar tendons, and the ACL were harvested from 26 autopsies (average age 36.4) and were
investigated using light and electron microscopy, immunohistochemistry and morphometry. The thickness of the collagen fibrils,
collagen organization and diameter, the fibril/interstitium ratio, density of fibroblasts and blood vessels, and distribution
of the collagen type I, III and V fibrils were analyzed. The semitendinosus showed the highest density of fibroblasts and
blood vessels, while the gracilis the highest fibril/interstitium ratio. No differences regarding the thickness of collagen
fibrils and distribution of fibrils were found. The ACL had the highest concentration of type III and V collagen fibrils as
well as elastic fibers. The histological and ultrastructural appearance of the ACL differs from those of the tendons used
as graft, for ACL reconstruction. Its ultrastructure is varied and complex, with its collagen fibers bundles lying in many
directions.
Keywords ACL reconstruction - Tendon graft - Comparative morphology - Morphometry - Cadaveric study