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Blood and lymph supply of the anterior cruciate ligament: Cadaver study by immunohistochemical and histochemical methods

  • Original Articles
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Journal of Orthopaedic Science

Abstract

Injection techniques, immunohistochemical (antibodies against laminin), and histochemical (5-nucleotidase activity) methods were used to demonstrate the vascular pattern of the human anterior cruciate ligament (ACL). The major blood supply of the ACL arises from the middle geniculate artery. The distal part of the ACL is vascularized by branches of the inferior geniculate artery. The ligament is covered by a synovial fold where the terminal branches of the middle and the inferior geniculate artery form a periligamentous network. From the synovial sheath, the blood vessels penetrate the ligament in a horizontal direction and anastomose with a longitudinally orientated intraligamentous network. Within the ligament, the blood vessels are located in the loose connective tissue that is located between longitudinal fiber bundles. Compared to the surrounding synovial layer, the number of vessels in the ligament substance is greatly reduced. Three avascular areas can be detected within the ligament. In the attachment zones of the ligament to the femur and the tibia, the immunohistochemical reaction with antibodies against laminin is negative. A third avascular zone is located in the anterior portion approximately 0.5 cm proximal to the tibial insertion. The absence of blood vessels in this area may be the result of compressive stress caused by the anterior end of the notch. Lymphatics accompany most of the smaller blood vessels, showing similar regional distribution.

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References

  1. Amiel D, Billings J, Akeson WH. Ligament structure, chemistry, and physiology. In: Daniel D, editor. Knee ligaments: Structure, function and repair. New York: Raven, 1989:34–45.

    Google Scholar 

  2. Alm A, Strömberg B. Vascular anatomy of the patella and cruciate ligaments. A microangiographic and histologic investigation in the dog. Acta Chir Scand 1974;445:23–35.

    Google Scholar 

  3. Arnoczky SP. Blood supply to the anterior cruciate ligament and supporting structures. Orthop Clin North Am 1985;16:15–27.

    PubMed  CAS  Google Scholar 

  4. Arnoczky SP, Rubin RM, Marshall JL. Microvasculature of the cruciate ligament and its response to injury. J Bone Joint Surg Am 1982;61:1221–1229.

    Google Scholar 

  5. Arnoczky SP, Matyas JR, Buckwalter JA, et al. Anatomy of the anterior cruciate ligament. In: Jakeson OW, editor. The anterior cruciate ligament: Current and future concepts. New York: Raven, 1993:1–15.

    Google Scholar 

  6. Benninghoff A. Form und Bau der Gelenkknorpel in ihren Beziehungen zur Funktion. Erste Mitteilung: Die modellierenden und formerhaltenden Faktoren des Knorpelreliefs. Z Anat Entwickl Gesch 1925;76:43–63.

    Article  Google Scholar 

  7. Benjamin M. Fibrocartilage, J Anat 1990; 171:1–15.

    PubMed  CAS  Google Scholar 

  8. Benjamin M, Quin S, Ralphs JR. Fibrocartilage associated with human tendons and their pulleys. J Anat 1995;187:626–633.

    Google Scholar 

  9. Bomberg BC, Mc Ginty JB. Acute hemarthrosis of the knee: Indications for diagnostic arthroscopy. Arthroscopy 1990;6:221–5.

    Article  PubMed  CAS  Google Scholar 

  10. Cooper RR, Misol S. Tendon and ligament insertion. J Bone Joint Surg Am 1979;53:1–20.

    Google Scholar 

  11. Casteleyn PP, Handelberg F, Opdecam P. Traumatic hemarthrosis of the knee. J Bone Joint Surg Br 1988;70:404–406.

    PubMed  CAS  Google Scholar 

  12. Davies DV, Edwards DAW. The blood supply of the synovial membrane and intra-articular structures. Ann R Coll Surg Engl 1948;2:142–56.

    CAS  PubMed  Google Scholar 

  13. De Haven KE. Diagnosis of acute knee injuries with hemarthrosis. Am J Sports Med 1980;8:9–14.

    Google Scholar 

  14. Dunn LD. Infection. In: Greenfield LJ, editor. Surgery. Philadelphia: JB Lippincott, 1993:148–70.

    Google Scholar 

  15. Greenfield LJ. Lymphatic system disorders. In: Greenfield LJ, editor. Surgery. Philadelphia: JB Lippincott, 1993:1784–91.

    Google Scholar 

  16. Gillquist J, Hagberg G, Oretorp N. Arthroscopy in acute injuries of the knee joint. Acta Orthop Scand 1977;48:190–6.

    PubMed  CAS  Google Scholar 

  17. Heusermann U. Morphologie der Lymphgefäße, der Nerven, der Kapsel und der Trabekel der menschlichen Milz (Thesis for university lecturing qualification, Christian-Albrechts-University Kiel). Medizinische Fakultät Kiel, 1979.

  18. Kannus P, Järvinen M. Conservatively treated of the anterior cruciate ligament. J Bone Joint Surg Am 1987;66:1007–11.

    Google Scholar 

  19. Knese KH, Biermann H. Die Knochenbildung an Sehnen-und Bandansätzen im Bereich ursprünglich chondraler Apophysen. Z Zellforsch 1958:49:142–87.

    Article  PubMed  CAS  Google Scholar 

  20. Koch S, Tillmann B. The distal tendon of biceps brachii. Ann Anat 1995;177:467–74.

    PubMed  CAS  Google Scholar 

  21. Leonhardt H. Lymphatische Organe. In: Leonhardt H, editor. Histologie, Zytologie und Mikroanatomie des Menschen. Stuttgart: Thieme, 1985;158–70.

    Google Scholar 

  22. Lyon RM, Akeson WH, Amiel D, Kitabayashi LR, Woo SLY. Ultrastructural differences between the cells of the medial collateral and the anterior cruciate ligaments. Clin Orthop 1991;272:279–86.

    PubMed  Google Scholar 

  23. Pauwels F. Eine neue Theorie über den Einfluß mechanischer Reize auf die Differenzierung der Stützgewebe. Zehnter Beitrag zur funktionellen Anatomie und kausalen Morphologie des Stützapparates. Z Anat Entwickl Gesch 1960;121:478–515.

    Article  CAS  Google Scholar 

  24. Petersen W, Tillmann B. Blood and lymph supply of the knee joint meniscus. Acta Orthop Scand 1995;66:303–7.

    Google Scholar 

  25. Pfab B. Zur Blutgefäßversorgung der Menisci und Kreuzbänder. Deutsche Zeitschr Chir 1927;205:258–64.

    Google Scholar 

  26. Rudert M, Tillmann B. Lymph and blood supply of the human intervertebral disc. Cadaver study of correlations to discitis. Acta Orthop Scand 1993;64:37–40.

    PubMed  CAS  Google Scholar 

  27. Rubin RM, Marshall JL. Vascular anatomy of the cruciate ligaments in the dog—normal and injured states. Trans Orthop Res Soc 1976;1:148.

    Google Scholar 

  28. Scapinelli R. Studies on the vasculature of the human knee joint. Acta Anat 1968;70:305–31.

    Article  PubMed  CAS  Google Scholar 

  29. Simonsen O, Jenson J, Lauritzen J. Arthroscopy in acute traumatic hemarthrosis of the knee. Acta Orthop Scand 1986;57:126–9.

    Article  PubMed  CAS  Google Scholar 

  30. Spalteholz KW. Über das Durchsichtigmachen von menschlichen und tierischen Präparaten. Leipzig, Hirzel, 1914.

    Google Scholar 

  31. Timpl R, Rohde H, Robey PG, et al. Laminin, a glycoprotein from basement membranes. J Biol Chem 1979;254:9933–7.

    PubMed  CAS  Google Scholar 

  32. Tillmann B, Schünke M. Funktionelle Anpassungsvorgänge an Binde- und Stützgeweben. Prakt Orthop 1991;23:22–7.

    Google Scholar 

  33. Tillmann B, Schünke M, Röddecker K. Struktur der Supraspinatussehne. Anat Anz 1991;172:82–3.

    Google Scholar 

  34. Vetter W. Alkalische Phosphatasen in Mastzellen, Blut- und Lymphgefäßen der Rattenzunge—5′ Nucleotidase-, unspezifische Phosphatase- und Polyphosphatase-(ATPase) Aktivität unter besonderer Berücksichtigung des pH. Z Anat Entwickl Gesch 1970;130:153–76.

    Article  Google Scholar 

  35. Werner JA, Schünke M, Tillmann B. Histochemical visualisation of lymphatic capillaries in the rat: A comparison of methods demonstrated at the posterior pharyngeal surface. Arch Histol Cytol 1987;50:505–14.

    CAS  Google Scholar 

  36. Zahm H. die Ligamenta decussata in gesunden und arthrotischen Gelenken des Hundes. Kleintierpraxis 1965;10:38–47.

    Google Scholar 

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Authors and Affiliations

  1. Lubinusklinik, Hospital for Surgery and Orthopaedic Surgery, Steenbeker Weg 25, 24106, Kiel, Germany

    Wolf Petersen & Ute Hansen

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  1. Wolf Petersen
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  2. Ute Hansen
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Petersen, W., Hansen, U. Blood and lymph supply of the anterior cruciate ligament: Cadaver study by immunohistochemical and histochemical methods. J Orthop Sci 2, 313–318 (1997). https://doi.org/10.1007/BF02488915

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  • DOI: https://doi.org/10.1007/BF02488915

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