Histological and ultrastructural evaluation of the early healing of the lateral collateral ligament epiligament tissue in a rat knee model

Georgiev, G; Vidinov, N.; Kinov, Plamen

doi:10.1186/1471-2474-11-117

Cited by 18 publications

(58 citation statements)

References 16 publications

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“…Single or rarely small groups of collagen fibers arranged chaotically, did not reveal a well-presented recovery of the EL. Wellpresented immunostaining for collagen type I and III (current results, Figure 7) and weak immunopositive reaction for collagen type V was detected at 8 day after healing throughout the MCL EL scar [10,30]. Light microscopy research on the sixteenth day after injury showed similar features as in previous period, but the granulation margins in the EL were less distinct and the area of scar formation appeared to be more organized (Figure 8).…”

Section: El Role During Ligament Healing (Light Electron Microscopicsupporting

confidence: 56%

“…The latter compose the ligament scar tissue and are mostly responsible for the collagen fibers synthesis. According to Georgiev et al [9,10] …”

Section: Types Of Cells (Light Electron Microscopy)mentioning

confidence: 99%

“…The latter compose the ligament scar tissue and are mostly responsible for the collagen fibers synthesis. According to Georgiev et al [9,10] (Figure 3). Georgiev et al [9,10], stated that the EL is composed of different types of fibroblasts: with large nuclei and well visible nucleoli and long cytoplasmic processes; spindle shaped fibroblasts; small elongated fibroblasts, fibroblasts with irregular form.…”

Section: Types Of Cells (Light Electron Microscopy)mentioning

confidence: 99%

“…In healthy EL a small amount of immunopositive reaction for type III collagen was detected in tunica media of the blood vessels. The collagen type V was localized only in the epiligament [9,10].Presence of collagen type I and V is described in the EL. It was observed that the thick collagen fibrils split off in thinner fibers [9].…”

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confidence: 99%

“…Figure 6: Transmission electron microscopy of the epiligament at the eight day after injury presented intensive angiogenesis with increased number of blood vessels (arrows) in the EL. Bar 1 μm.Currently, there are only few studies that describe the morphological features of the EL of collateral ligaments of the knee joint in different animal models [4,5,8,10,13,15,26,27,29,30]. According to Lo et al [13], it is possible EL to be the major source of cells engaged in the ligament scars formation during ligament healing.…”

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confidence: 99%

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The Epiligament-The Main Donor of Cells and Vessels during Healing Of the Collateral Ligaments of the Knee

Landzhov¹

2015

Anat Physiol

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Ligaments are composed of dense connective tissue and attach bones in joints. The thin connective tissue sheath, covering these fascicles is called endoligament and is connected to a more vascular connective tissue structure that envelopes the entire ligament and is referred to as epiligament. The tissue of the epiligaments is composed of different cell types such as: fibroblasts, fibrocytes, adipocytes, neurovascular bundles, and a multitude of collagen fibers, disposed in different directions. The main structural protein of epiligament is collagen type I. Collagens types III and V were also found in the structure of epiligament. Type I collagen is the main collagen in normal and healing ligaments. The ligament repair requires presence of collagen type III. Collagen type V is associated with collagen type I and regulates the collagen fibril diameter. Knowledge of variation of cells and collagen types of epiligament in normal and injured ligaments is crucial for understanding of the healing process. Keywords: Collateral ligament epiligament; Knee Abbreviations:EL: Epiligament; MCL: Medial Collateral Ligament Ligament and Epiligament (EL) StructureThe structures, composed of dense connective tissues that attach bones in joints are known as ligaments. The main components of ligaments connective tissue are ligament cells and extracellular matrix [1,2]. The internal gross organization of ligaments includes fascicles which are composed of collagen fibers arranged in longitudinal groups [3]. The thin connective tissue sheath, covering these fascicles is called endoligament and is connected to a more vascular connective tissue structure that envelopes the entire ligament and is referred to as epiligament (EL) [4].The first definition of the term in the scientific literature is given by Bray et al. [5], described it as "surrounding adherent connective tissue removed simultaneously with the ligament but which was grossly distinguishable from ligament tissue proper". In the external area of medial collateral ligament (MCL) in rabbits only two types of cells were observed -spinous and cuboidal shaped fibroblasts and fat cells [4]. In addition Georgiev et al. [6,7] described different types of fibroblasts -spinous-shaped, spindle-shaped, elongated, irregular in shape and fat cells.There are relatively few data about the structural and physiological features of the EL, therefore herein we review the existing data about this structure in the literature and lay emphasis on its clinical significance. Macroscopic AppearanceThe EL is a thin translucent layer which entirely covers the ligament and in the same time mobile in all directions. Its compliance is higher than that of the underlying ligament. At the ligament insertion sites the EL is continuous with the periosteum. It is attached to the MCL by fronds of synovium. In the deeper areas which are towards the joint cavity, the EL is attached tighter to the ligament than in the superficial ones. The EL is more difficult to distinguish from MCL in immature animals. There...

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Section: El Role During Ligament Healing (Light Electron Microscopicsupporting

confidence: 56%

“…The latter compose the ligament scar tissue and are mostly responsible for the collagen fibers synthesis. According to Georgiev et al [9,10] …”

Section: Types Of Cells (Light Electron Microscopy)mentioning

confidence: 99%

Section: Types Of Cells (Light Electron Microscopy)mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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The Epiligament-The Main Donor of Cells and Vessels during Healing Of the Collateral Ligaments of the Knee

Landzhov¹

2015

Anat Physiol

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Ligamentous healing potential of the acromioclavicular ligament following acute anatomical reconstruction

Tuecking

Erdle

Bernstein

et al. 2021

Arch Orthop Trauma Surg

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Background Horizontal instability following acute acromioclavicular joint (ACJ) reconstruction still occurs with a high prevalence. Although the human acromioclavicular ligament complex (ACLC) represents the major horizontal ACJ stabilizer, experimental studies on healing characteristics are lacking. Therefore, the purpose of this histological study was to investigate the healing potential of the ACLC following acute anatomical reconstruction Methods In this prospective clinical-experimental study, 28 ACLC biopsies were performed in patients with complete ACJ dislocations (Rockwood type 4 or 5) during acute hook plate stabilization (IG: implantation group; n = 14) and hook plate removal (EG: explantation group; n = 14). Histological analyses included Giemsa staining, polarized light microscopy and immunostaining against CD68, αSMA and collagen type I and type III. Histomorphological evaluation entailed cell counts, collagen expression score, ligament tissue maturity index (LTMI) and descriptive analysis of specific ligamentous structures. Statistics consisted of nonparametric Mann–Whitney U tests and a level of significance of P < .05. Results Total cell counts (cells/mm2 1491 ± 296 vs. 635 ± 430; P < 0.001) and collagen III expression (3.22 ± 0.22 vs. 1.78 ± 0.41; P < 0.001) were higher in EG compared to IG. Inversely αSMA + (11 ± 9 vs. 179 ± 186; P < 0.001) and CD68 + cell counts (56 ± 20 vs. 100 ± 57; P 0.009) were significantly lower in the EG. The EG revealed a comparable reorientation of ligamentous structures. Consistently, ACLC samples of the EG (21.6 ± 2.4) displayed a high total but differently composed LTMI score (IG: 24.5 ± 1.2; P < 0.001). Conclusions This experimental study proved the ligamentous healing potential of the human ACLC following acute anatomical reconstruction. Histomorphologically, the ACLC reliably showed a ligamentous state of healing at a mean of about 12 weeks after surgery. However, processes of ligamentous remodeling were still evident. These experimental findings support recent clinical data showing superior horizontal ACJ stability with additional AC stabilization in the context of acute ACJ reconstruction. Though, prospective clinical and biomechanical studies are warranted to evaluate influencing factors on ACLC healing and potential impacts of acute ACLC repair on clinical outcome. Study type Controlled Laboratory Study

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A comparative study of the epiligament of the medial collateral and the anterior cruciate ligament in the human knee. Immunohistochemical analysis of collagen type I and V and procollagen type III

Georgiev

Kotov

Iliev

et al. 2019

Annals of Anatomy - Anatomischer Anzeiger

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Histological and ultrastructural evaluation of the early healing of the lateral collateral ligament epiligament tissue in a rat knee model

Cited by 18 publications

References 16 publications

The Epiligament-The Main Donor of Cells and Vessels during Healing Of the Collateral Ligaments of the Knee

The Epiligament-The Main Donor of Cells and Vessels during Healing Of the Collateral Ligaments of the Knee

Ligamentous healing potential of the acromioclavicular ligament following acute anatomical reconstruction

A comparative study of the epiligament of the medial collateral and the anterior cruciate ligament in the human knee. Immunohistochemical analysis of collagen type I and V and procollagen type III

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