Abstract
To evaluate proprioceptive potential in residual remnants, tissue harvested from ruptured ACLs in 63 consecutive patients was examined for evidence of residual proprioceptive fibres using H&E, and monoclonal antibodies to S-100 and NFP (neurofilament protein). Histological examination showed good subsynovial and intra-fascicular vascularity with free nerve endings in the majority. Morphologically normal mechanoreceptors (H&E) and proprioceptive fibres (positivity with monoclonal antibody for NFP) were found in 46% and 52.4% of stumps, respectively. A statistically significant correlation between injury duration and persistence of mechanoreceptors and proprioceptive fibres was noted. More fibres were seen where ACL remnant was adherent to PCL. Our study has shown that persistent residual proprioceptive fibres in injured ACLs (especially early cases with PCL adherence) are significant; not shaving ACL remnants may be of potential benefit during ACL reconstruction, as some re-innervation and recovery of proprioceptive potential may be possible, thus improving clinical outcomes.
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References
Bonci CM (1999) Assessment and evaluation of predisposing factors to anterior cruciate ligament injury. J Athl Train 34(2):155–164
McDaniel WJ Jr, Dameron TB Jr (1983) The untreated anterior cruciate ligament rupture. Clin Orthop Relat Res 172:158–163
Borsa PA, Lephart SM, Irrgang JJ, Safran MR, Fu FH (1997) The effects of joint position and direction of joint motion on proprioceptive sensibility in anterior cruciate ligament-deficient athletes. Am J Sports Med 25(3):336–340
Denti M, Monteleone M, Berardi A, Panni AS (1994) Anterior cruciate ligament mechanoreceptors. Clin Orthop Relat Res 308:29–32
Johansson H, Sjolander P, Sojka P (1991) Receptors in knee joint and their role in biomechanics of joint. Crit Rev Biomed Eng 18(5):341–368
Johansson H, Sjolander P, Sojka P (1991) A sensory role for the cruciate ligaments. Clin Orthop Relat Res 268:161–178
Zimny ML, Schutte M, Dabezies E (1986) Mechanoreceptors in the human anterior cruciate ligament. Anat Rec 214(2):204–209
Schultz RA, Miller DC, Kerr CS, Micheli L (1994) Mechanoreceptors in human cruciate ligaments. A histological study. J Bone Joint Surg Am 66(7):1072–1076
Schutte MJ, Dabezies EJ, Zimny ML, Happel LT (1987) Neural anatomy of the human anterior cruciate ligament. J Bone Joint Surg Am 69(2):243–247
Paterson FWN, Trickey EL (1986) Anterior cruciate ligament reconstruction using patellar tendon as a graft. J Bone Joint Surg Br 68(B):453–457
Noyes FR, Butler DL, Paulos LE, Grood ES (1983) Intraarticular cruciate reconstruction. I: Perspective on graft strength, vascularisation and immediate motion after placement. Clin Orthop Relat Res 172:71–77
Arnoczky SP, Tarvin GB, Marshall JL (1982) Anterior cruciate ligament replacement using patellar tendon. An evaluation of graft revascularization in the dog. J Bone Joint Surg Am 64(2):217–224
Mayr HO, Weig TG, Plitz W (2004) Arthrofibrosis following ACL reconstruction–reasons and outcome. Arch Orthop Trauma Surg 124(8):518–522
Recht MP, Piraino DW, Cohen MA, Parker RD, Bergfeld JA (1995) Localized anterior arthrofibrosis (cyclops lesion) after reconstruction of the anterior cruciate ligament: MR imaging findings. AJR Am J Roentgenol 165(2):383–385
Georgoulis AD, Pappa L, Moebius U et al (2001) The presence of proprioceptive mechanoreceptors in the remnants of ruptured ACL as possible source of reinnervation of ACL autograft. Knee Surg Sports Traumatol Arthrosc 9(6):364–368
Barrett DS (1991) Proprioception and function after anterior cruciate ligament reconstruction. J Bone Joint Surg Br 73(5):833–837
Ochi M, Iwasa J, Uchio Y et al (1999) The regeneration of sensory neurons in the reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 81(5):902–906
Fromm B, Kummer W (1994) Nerve supply of anterior cruciate ligaments and of cryopreserved anterior cruciate ligament allografts: a new method for the differentiation of the nervous tissues. Knee Surg Sports Traumatol Arthrosc 2(2):118–122
Parsch D, Fromm B, Kummer W (1996) Projections and fiber characteristics of sensory afferents of the anterior cruciate ligament in an animal experiment. Unfallchirurgie 22(5):193–201
Krauspe R, Schmitz F, Zöller G, Drenckhahn D (1995) Distribution of neurofilament-positive nerve fibres and sensory endings in the human anterior cruciate ligament. Arch Orthop Trauma Surg 114(4):194–198
Del Valle ME, Harwin SF, Maestro A et al (1998) Immunohistochemical analysis of mechanoreceptors in the human posterior cruciate ligament: a demonstration of its proprioceptive role and clinical relevance. J Arthroplasty 13(8):916–922
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Dhillon, M.S., Bali, K. & Vasistha, R.K. Immunohistological evaluation of proprioceptive potential of the residual stump of injured anterior cruciate ligaments (ACL). International Orthopaedics (SICOT) 34, 737–741 (2010). https://doi.org/10.1007/s00264-009-0948-1
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DOI: https://doi.org/10.1007/s00264-009-0948-1