Histological Assessment of Mechanoreceptors in Achilles Allografts After Anterior Cruciate Ligament Reconstruction

Kim, Sung Hun; Chun, Churl Hong; Chun, Keun Churl; Jo, Hyang Jeong; Kim, Kwang Mee

doi:10.1177/0363546512453303

Cited by 28 publications

(38 citation statements)

References 17 publications

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“…Thus to preserve or to ensure the innervation of the reconstructed ACL should be a main scope of ACR reconstructive surgery [4][5][6]. Sensory innervation is absent from reconstructed ACL [7,21]while innervation has been demonstrated in grafts inserted in ACL remnants [17][18][19][20].…”

Section: Discussionmentioning

confidence: 99%

“…In patients with cruciate-retaining total knee arthroplasty mechanoreceptors are present 5 to 12 years later [16], and residual remnants of ruptured ACL contain morphologically normal mechanoreceptors and proprioceptive fibbers evenly distributed at both tibial and femoral attachments in one third of the cases [17][18][19][20]. Conversely, other researchers reported the absence of mechanoreceptors in biopsy samples of ACL after reconstruction with Achilles allografts (1 to 10 years), and absence of sensory function after ACL re-construction, presumably because the ACL grafts were not reinnervated [7,21]. To avoid nerve defects in ACL reconstruction alternative surgical procedures have been proposed.…”

Section: Introductionmentioning

confidence: 99%

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Innervation of Partially Inserted Human Tendons Used to Reconstruct Anterior Cruciate Ligament

Ja¹

2017

MOJAP

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Aim: The human anterior cruciate ligament (ACL) provides sensory information to the nervous system that controls the activity of periarticular knee muscles. Thus, ensure the innervation of reconstructed anterior cruciate ligament lead to a better proprioception. Here we investigated the innervation of a unique case of anterior cruciate ligament reconstructed using the semitendinosus and gracilis muscle tendons maintaining the tibial insertions, 12 years after reconstruction. The study was aimed to investigate whether these pieces contain mechanoreceptors and have a pattern of innervation similar to that proper of ACL. Materials and Methods:Immunohistochemistry for general nerve markers (neurons specific enolase, neurofilament proteins, and S100 protein) and putative mechanoproteins (acid-sensing ion channel 2 and transient receptor potential vanilloid 4) was used to map and characterize the nerves in normal ACL and the reconstructed ACL.Results: Perivascular nerves, free nerve endings, Pacini-like and Ruffini-like corpuscles were observed, and mechanoproteins were detected in both free nerve endings and corpuscles, in normal ACL. In the ACL tendon-reconstructed ACL there was a severe reduction in the density of nerve profiles, and especially of sensory corpuscles, which were restricted to the segments closest to the tibial insertion. Conclusion:Normal human ACL has a rich innervation that is strongly severed after tendon-graft reconstructed ACL, even when if remains partially inserted and after long-term survival.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Innervation of Partially Inserted Human Tendons Used to Reconstruct Anterior Cruciate Ligament

Ja¹

2017

MOJAP

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“…The inclusion of proprioceptive exercises after anatomic reattachment of the volar and dorsal radioulnar ligaments is recommended during the postoperative followup, after the required period of immobilization for ligament healing has passed [9]. Contrarily, surgical procedures aiming to reconstruct the radioulnar ligaments with a tendon graft [1], will not address the sensory function of the volar and dorsal radioulnar ligaments, and consequently fail to account for the dynamic aspects of distal radioulnar joint stability [13].…”

Section: Clinical Relevancementioning

confidence: 99%

Immunohistochemical Mapping of Sensory Nerve Endings in the Human Triangular Fibrocartilage Complex

Rein

Semisch

García-Elias

et al. 2015

Clin Orthop Relat Res

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Background The triangular fibrocartilage complex is the main stabilizer of the distal radioulnar joint. While static joint stability is constituted by osseous and ligamentous integrity, the dynamic aspects of joint stability chiefly concern proprioceptive control of the compressive and directional muscular forces acting on the joint. Therefore, an investigation of the pattern and types of sensory nerve endings gives more insight in dynamic distal radioulnar joint stability.Questions/purposes We aimed to (1) analyze the general distribution of sensory nerve endings and blood vessels; (2) examine interstructural distribution of sensory nerve endings and blood vessels; (3) compare the number and types of mechanoreceptors in each part; and (4) analyze intrastructural distribution of nerve endings at different tissue depth. Methods The subsheath of the extensor carpi ulnaris tendon sheath, the ulnocarpal meniscoid, the articular disc, the dorsal and volar radioulnar ligaments, and the ulnolunate and ulnotriquetral ligaments were dissected from 11 human cadaver wrists. Sensory nerve endings were counted in five levels per specimen as total cell amount/ cm 2 after staining with low-affinity neurotrophin receptor p75, protein gene product 9.5, and S-100 protein and thereafter classified according to Freeman and Wyke. Results All types of sensory corpuscles were found in the various structures of the triangular fibrocartilage complex with the exception of the ulnolunate ligament, which contained only Golgi-like endings, free nerve endings, and unclassifiable corpuscles. The articular disc had only free nerve endings. Furthermore, free nerve endings were the predominant sensory nerve ending (median, 72.6/cm 2 ; range, 0-469.4/cm 2 ) and more prevalent than all other types of mechanoreceptors: Ruffini (median, 0; range, 0-5.6/cm 2 ; difference of medians, 72.6; p \ 0.001), Pacini (median, 0; range, 0-3.8/cm 2 ; difference of medians, 72.6; p \ 0.001), Golgi-like (median, 0; range, 0-2.1/cm 2 ; difference of medians, 72.6; p \ 0.001), and unclassifiable corpuscles (median, 0; range, 0-2.5/cm 2 ; difference of medians, 72.6; p \ 0.001). The articular disc contained fewer free nerve endings (median, 1.8; range, 0-17.8/cm 2 ) and fewer blood vessels (median, 29.8; range, 0-112.2/ cm 2 ; difference of medians: 255.9) than all other structures of the triangular fibrocartilage complex (p B 0.001, respectively) except the ulnolunate ligament. More blood vessels were seen in the volar radioulnar ligament (median, 363.62; range, 117.8-871.8/cm 2 ) compared with the ulnolunate ligament (median, 107.7; range, 15.9-410.3/cm 2 ; difference of medians: 255.91; p = 0.002) and the dorsal radioulnar ligament (median, 116.2; range, 53.9-185.1/ cm 2 ; difference of medians: 247.47; p = 0.001). Free nerve endings were obtained in each structure more often than all other types of sensory nerve endings (p \ 0.001, respectively). The intrastructural analysis revealed no differences in mechanoreceptor distribution in all investigat...

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“…These ndings suggest that ACL remnants are a possible source of re-innervation of the tendon graft. However, previous histological studies have failed to validate the presence of mechanoreceptors in ACL allografts [10]. In addition, few studies have quantitatively evaluated neural elements in ACL remnants and ACL allografts.…”

Section: Introductionmentioning

confidence: 99%

Quantitative assessment of neural elements in a rat model using nerve growth factor after remnant-preserving anterior cruciate ligament reconstruction: a histological and immunofluorescence pilot study

Lee

Cho

Song

et al. 2020

Preprint

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Abstract Background: Immunofluorescence analyses of anterior cruciate ligament (ACL) allografts following remnant-preserving ACL reconstruction using Achilles tendon allografts have provided evidence for the presence of neural elements. In this study, we aimed to examine the expression of neural elements and quantify the presence of neural cells in ACL remnants and Achilles allografts using nerve growth factor (NGF) therapy after remnant-preserving ACL reconstruction.Methods: Experiments were conducted on 5 pairs of rats (approximately 8 weeks old and weighing 320 g at the time of surgery). Longitudinally split Achilles tendons from the paired rats were freshly frozen and later defrosted with warm saline and allografted onto the right ACL of the other rat that was partially detached at the femoral attachment site. A sham operation was conducted on the left knee to be used as a control. NGF was injected into both knee joints every week for 6 weeks after surgery. The presence of neural cells in the ACL of the sham-operated knee, allografted Achilles tendon, and ACL remnant was examined 6 weeks post-surgery using H and E and immunofluorescent staining.Results: H and E staining did not reveal neural cells in any of the three groups. However, immunofluorescence analysis showed the presence of nestin-positive neural elements in the normal ACL tissues as well as ACL remnants. Additionally, neural elements were examined in 7 of the 8 (87.5%) allograft tissues. Quantitative analysis showed no difference in the number or area of nuclei among the three groups. However, the number and area of neural cells in the Achilles allografts were significantly lower than those in the other two groups (p=0.000 and p=0.001, respectively).Conclusion: Our observations indicate that ACL remnants promote the new ingrowth and persistence of neural cells. We suggest that the ingrowth of neural elements can support the persistence and new ingrowth of mechanoreceptors, thereby enhancing the functional stability of knee joints. Moreover, the expression of neural cells in the Achilles allografts was lower than that in normal ACL tissues and ACL remnants in the quantitative evaluation, thereby confirming the essential role of ACL remnants in knee joint functionalization.

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Histological Assessment of Mechanoreceptors in Achilles Allografts After Anterior Cruciate Ligament Reconstruction

Abstract: The results demonstrate that Achilles tendon allografts appeared similar to normal ligaments except for the lack of histological evidence of mechanoreceptors. In other words, there are no newly ingrown mechanoreceptors in ACL allografts.

Cited by 28 publications

References 17 publications

Innervation of Partially Inserted Human Tendons Used to Reconstruct Anterior Cruciate Ligament

Innervation of Partially Inserted Human Tendons Used to Reconstruct Anterior Cruciate Ligament

Immunohistochemical Mapping of Sensory Nerve Endings in the Human Triangular Fibrocartilage Complex

Quantitative assessment of neural elements in a rat model using nerve growth factor after remnant-preserving anterior cruciate ligament reconstruction: a histological and immunofluorescence pilot study

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