1
|
Li X, Li H, Su J, Ding R. Anterior cruciate ligament femoral side retained stump technique reduces enlargement of the femoral bone tunnel after anterior cruciate ligament reconstruction. BMC Musculoskelet Disord 2024; 25:380. [PMID: 38745214 PMCID: PMC11092199 DOI: 10.1186/s12891-024-07464-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/22/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Enlargement of the bone tunnel has become an unavoidable early complication after anterior cruciate ligament (ACL) reconstruction, whether it is a single or double-bundle ACL reconstruction. Preservation of the ACL stump in ACL reconstruction reduces enlargement of the bone tunnel. The purpose of this study was to investigate the question of whether single-bundle ACL reconstruction using the ACL femoral side retained stump technique reduces enlargement of the femoral tunnel. METHODS Forty patients who underwent single-bundle reconstruction of the ACL were included in this study. The patients were categorized into a Remnant preservation group (Group R) and the Non-remnant preservation group (Group N). In the Remnant preservation group, a high-flexion femoral side retained stump technique was used intraoperatively for the establishment of the femoral side bone tunnel, and in the Non-remnant preservation group, the conventional femoral positioning method was used (we used a femoral positioning drill for localization and drilling of the femoral bone tunnel), and MRI of the operated knee joints was performed at 6 months postoperatively. We measured the internal diameter of the femoral bone tunnel at 5 mm from the intra-articular outlet of the femoral bone tunnel on an MRI scan image perpendicular to the femoral bone tunnel. The size of the tunnel was compared between the intraoperative drilling of the bone tunnel and the size of the bone tunnel at 6 months postoperatively. Postoperative clinical assessment was Lysholm score. RESULTS After a 6-month follow-up of 40 patients, the diameter of the femoral tunnel at a distance of 5 mm from the inner opening of the femoral tunnel was 10.96 ± 0.67 mm and 10.11 ± 0.62 mm in patients of group N and group R, respectively, and the difference was statistically significant (P < 0.05).The diameter of the femoral tunnel at 6 months postoperatively in group N and group R compared to the intraoperative bone tunnel increased by 2.58 ± 0.24 mm and 1.94 ± 0.31 mm, and the difference was statistically significant (P < 0.05).The femoral tunnel enlargement rates of group N and group R were 30.94 ± 3.00% and 24.02 ± 5.10%, respectively, and the differences were significant (P < 0.05). CONCLUSION ACL femoral side retained stump technique does not sacrifice the ideal location of the femoral tunnel and is able to preserve the possible benefits of the ACL stump: reduced femoral tunnel enlargement.
Collapse
Affiliation(s)
- Xiaobo Li
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Hanlin Li
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- Clinical Medicine, Wuhan University of Science and Technology, 2 West Huangjiahu Road, Hongshan District, Wuhan, Hubei Province, China
| | - Jixian Su
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China
- Clinical Medicine, Wuhan University of Science and Technology, 2 West Huangjiahu Road, Hongshan District, Wuhan, Hubei Province, China
| | - Ran Ding
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Wuchang District, Wuhan, Hubei Province, China.
| |
Collapse
|
2
|
Sun Y, Huang Z, Zhang P, Xie H, Wang C, Deng Z, Chen K, Zhu W. Comparative Study of Graft Healing in 2 Years after “Tension Suspension” Remnant-Preserving and Non-Remnant-Preserving Anatomical Reconstruction for Sherman Type II Anterior Cruciate Ligament Injury. J Pers Med 2023; 13:jpm13030477. [PMID: 36983659 PMCID: PMC10059742 DOI: 10.3390/jpm13030477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
Purpose: To evaluate the degree of graft healing after “tension suspension” reconstruction of “Sherman II” anterior cruciate ligament injuries versus non-remnant preserving anatomical reconstruction and to compare the clinical outcomes of the two procedures. Method: The clinical data of 64 patients were retrospectively included. There were 31 cases in the “tension suspension” remnant-preserving reconstruction group and 33 cases in the non-remnant-preserving anatomical reconstruction group. The International Knee Documentation Committee (IKDC) score, the Tegner score, and the Lysholm activity score were assessed preoperatively and at 6 months, 1 year, and 2 years postoperatively, respectively. The signal/noise quotient (SNQ) of the grafts was measured at 6 months, 1 year, and 2 years after surgery to quantitatively evaluate the maturity of the grafts after ACL reconstruction; the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the reconstructed ACL region of interest (ROI) were measured using DTI. Result: A total of 64 patients were included in the study. The mean SNQ values of the grafts in the 6 months, 1 year, and 2 years postoperative remnant-preserving reconstruction (RP) groups were lower than those in the non-remnant-preserving (NRP) reconstruction group, with a statistically significant difference (p < 0.05). At each postoperative follow-up, the SNQ values of the tibial and femoral sides of the RP group were lower than those of the NRP group; the SNQ values of the femoral side of the grafts in both groups were higher than those of the tibial side, and the differences were statistically significant (p < 0.05). At 6 months, 1 year, and 2 years postoperatively, the FA and ADC values of the grafts were lower in the RP group than in the NRP group, and the differences were statistically significant (p < 0.05); the IKDC score and Lysholm score of the RP group were higher than the NRP group, which was statistically significant (p < 0.05). Conclusion: For Sherman II ACL injury, the graft healing including ligamentization and revascularization at 2 years after the “tension suspension” remnant-preserving reconstruction was better than that of non-remnant-preserving anatomic reconstruction.
Collapse
Affiliation(s)
- Yijia Sun
- Clinical College of the Second Shenzhen Hospital, Anhui Medical University, Shenzhen 518025, China
- Department of Sports Medicine, Shenzhen Second People’s Hospital, Shenzhen 518025, China
| | - Zirong Huang
- Department of Sports Medicine, Shenzhen Second People’s Hospital, Shenzhen 518025, China
- Clinical Medical College, Guangzhou Medical University, Guangzhou 511436, China
| | - Pingquan Zhang
- Clinical College of the Second Shenzhen Hospital, Anhui Medical University, Shenzhen 518025, China
- Department of Sports Medicine, Shenzhen Second People’s Hospital, Shenzhen 518025, China
| | - Huanyu Xie
- Department of Sports Medicine, Shenzhen Second People’s Hospital, Shenzhen 518025, China
| | - Chen Wang
- Department of Sports Medicine, Shenzhen Second People’s Hospital, Shenzhen 518025, China
| | - Zhenhan Deng
- Department of Sports Medicine, Shenzhen Second People’s Hospital, Shenzhen 518025, China
| | - Kang Chen
- Department of Sports Medicine, Shenzhen Second People’s Hospital, Shenzhen 518025, China
- Correspondence: (K.C.); (W.Z.)
| | - Weimin Zhu
- Clinical College of the Second Shenzhen Hospital, Anhui Medical University, Shenzhen 518025, China
- Department of Sports Medicine, Shenzhen Second People’s Hospital, Shenzhen 518025, China
- Correspondence: (K.C.); (W.Z.)
| |
Collapse
|
3
|
Çabuk H, Kuşku Çabuk F, Turan K. The time from injury to surgery is an important factor affecting the mechanoreceptors at stump of torn anterior cruciate ligament. Arch Orthop Trauma Surg 2022; 142:3389-3393. [PMID: 35048172 DOI: 10.1007/s00402-021-04310-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 12/07/2021] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Restoration of proprioceptive function after anterior cruciate ligament (ACL) reconstruction is as important as mechanical stability. For this purpose, remnant of the torn ACL is the only source of nerve endings. Our aim in this study is to investigate the quantity of mechanoreceptors in the remnants ACL stumps in injured knees and to correlate that with the quantity in intact ACL in control cases. MATERIALS AND METHODS 48 patients that underwent ACL reconstruction between January 2016 and December 2018 as study group and 20 knees of 10 fresh frozen cadavers that as control group included in the study. Remaining stumps from study group and native ACL from control group were collected and investigated with S100 immunostaining. The type and number of mechanoreceptors in standardized areas was determined. The correlation of number of mechanoreceptors and time to surgery after ACL rupture were evaluated. RESULTS The free nerve endings (FNE) and total number of mechanoreceptors were significantly lower in the study group as compared to the control group (p < 0.001 and p = 0.004, respectively). The number of Golgi-Mazzoni corpuscle decreased significantly with time (p = 0.041 CC: - 0.438). CONCLUSION The time from injury to surgery is an important factor affecting the mechanoreceptors at stump of torn ACL. The surgeon and patient should be aware of the fact that delay in surgery could lead to the loss of mechanoreceptors.
Collapse
Affiliation(s)
- Haluk Çabuk
- Department of Orthopedics and Traumatology, İstinye University, Istanbul, Turkey.
| | - Fatmagül Kuşku Çabuk
- Department of Pathology, Bakırköy DR. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Kaya Turan
- Department of Orthopedics and Traumatology, İstinye University, Istanbul, Turkey
| |
Collapse
|
4
|
Banios K, Raoulis V, Fyllos A, Chytas D, Mitrousias V, Zibis A. Anterior and Posterior Cruciate Ligaments Mechanoreceptors: A Review of Basic Science. Diagnostics (Basel) 2022; 12:diagnostics12020331. [PMID: 35204424 PMCID: PMC8870829 DOI: 10.3390/diagnostics12020331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/29/2021] [Accepted: 01/25/2022] [Indexed: 02/06/2023] Open
Abstract
Proprioception is a specialized sensory modality encompassing the movement of the joint and its position in space, and it involves the conversion of mechanical deformation of tissues into neural signals. Mechanoreceptors are specialized nerve structures able to transmit mechanical deformation through electrical signals to dorsal root ganglion sensory neurons and are abundant in the muscles, tendons and ligaments of the knee joint. They are believed to play an important role in knee proprioception and dynamic knee stability. Proprioception should always be taken into consideration for successful reconstruction of the cruciate-deficient knee and for pain and function management in the arthritic knee. Advances in histological methods of detection are numerous and continue to highlight the presence and role of mechanoreceptors after ligament reconstruction, depending on choice of graft. In this review, we present the current knowledge of anterior and posterior cruciate ligaments and grafts mechanoreceptors, and their role in proprioception of knee joint, focusing on each type of mechanoreceptors.
Collapse
Affiliation(s)
- Konstantinos Banios
- Department of Orthopedic Surgery, General Hospital of Karditsa, Peripheral Road Karditsa-Kastania, 43100 Karditsa, Greece;
- Laboratory of Anatomy, Department of Medicine, School of Health Sciences, University of Thessaly, 3 University Street, Biopolis, 41110 Larissa, Greece; (V.R.); (A.F.); (V.M.)
| | - Vasileios Raoulis
- Laboratory of Anatomy, Department of Medicine, School of Health Sciences, University of Thessaly, 3 University Street, Biopolis, 41110 Larissa, Greece; (V.R.); (A.F.); (V.M.)
| | - Apostolos Fyllos
- Laboratory of Anatomy, Department of Medicine, School of Health Sciences, University of Thessaly, 3 University Street, Biopolis, 41110 Larissa, Greece; (V.R.); (A.F.); (V.M.)
| | - Dimitrios Chytas
- Department of Physiotherapy, University of Peloponnese, 20 Plateon Street, 23100 Sparta, Greece;
| | - Vasileios Mitrousias
- Laboratory of Anatomy, Department of Medicine, School of Health Sciences, University of Thessaly, 3 University Street, Biopolis, 41110 Larissa, Greece; (V.R.); (A.F.); (V.M.)
- Department of Orthopedic Surgery, University of Thessaly, 3 University Street, Biopolis, 41110 Larissa, Greece
| | - Aristeidis Zibis
- Laboratory of Anatomy, Department of Medicine, School of Health Sciences, University of Thessaly, 3 University Street, Biopolis, 41110 Larissa, Greece; (V.R.); (A.F.); (V.M.)
- Correspondence:
| |
Collapse
|
5
|
Koc BB, Jansen EJP, van Dijk P, Emans PJ, Lataster A. Mechanoreceptors observed in a ligamentous structure between the posterior horn of the lateral meniscus and the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2021; 29:1701-1708. [PMID: 32740878 DOI: 10.1007/s00167-020-06191-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE A histological study of a structure between the posterior horn of the lateral meniscus and the anterior cruciate ligament. METHODS Bilateral fresh-frozen cadaveric knees of two male donors (age 71 and 76 years) with no history of prior knee injury were examined. All dissections were performed by one experienced orthopaedic surgeon. Haematoxylin and Eosin staining was used to reveal tissue morphology. Goldner trichrome staining was used to evaluate the connective tissue. S100 and PGP 9.5 labelling were used for immunohistochemical analysis. RESULTS In all cadaveric knees, a structure between the posterior horn of the lateral meniscus and the anterior cruciate ligament was identified. Histological analysis confirmed the ligamentous nature of this structure. Furthermore, Golgi tendon organs were observed within the ligamentous structure. CONCLUSION This is the first study showing the presence of mechanoreceptors within the ligamentous structure between the posterior horn of the lateral meniscus and the anterior cruciate ligament. The ligamentous structure could contribute to stability of the knee by providing proprioceptive input, while preservation of the ligamentous structure might ensure a better functional outcome after surgery.
Collapse
Affiliation(s)
- Baris B Koc
- Department of Orthopaedic Surgery, Zuyderland Medical Center, Dr. H. vd Hoffplein 1, 6162 AG, Sittard Geleen, The Netherlands.
| | - Edwin J P Jansen
- Department of Orthopaedic Surgery, Zuyderland Medical Center, Dr. H. vd Hoffplein 1, 6162 AG, Sittard Geleen, The Netherlands
| | - Paul van Dijk
- Department of Anatomy and Embryology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Pieter J Emans
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Arno Lataster
- Department of Anatomy and Embryology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
6
|
Distribution, quantity and gene expression of mechanoreceptors in ligaments and tendons of knee joint in rabbits. J Mol Histol 2020; 51:233-240. [PMID: 32356233 DOI: 10.1007/s10735-020-09875-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/25/2020] [Indexed: 01/12/2023]
Abstract
Here we investigated the morphology, quantity, distribution and gene expression of mechanoreceptors in the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), lateral collateral ligament (LCL), patellar tendon (PaT) and popliteal tendon (PoT) of the knee joint. Twelve 6-month-old rabbits were divided into two groups. In one group, the ACL, PCL, MCL, LCL, PaT and PoT were collected to observe the morphology, distribution and quantity of mechanoreceptors. In another group, the ACL, PCL, MCL, LCL, PaT and PoT of bilateral knee joints were used to determine S100B, CGRP and NEFM gene levels. Five types of mechanoreceptors were observed including Ruffini corpuscles, Pacinian corpuscles, Golgi-tendon bodies, atypical mechanoreceptors and free nerve endings. The total amount of mechanoreceptors was significantly lower in MCL, LCL, PaT and PoT as compared with ACL and PCL (P < 0.001). All examined mechanoreceptors were present in ACL, PCL and LCL. However, no Pacinian corpuscles and Golgi-tendon bodies were found in MCL and PoT as well as Pacinian corpuscles were not observed in PaT. The present study indicated that the levels of NEFM was significantly lower in PCL, MCL, LCL, PaT and PoT as compared with ACL (P < 0.05), but there was no significant difference in CGRP level between ACL and other ligaments except LCL (P > 0.05). Thus, the quantity, type and gene expression of mechanoreceptors are different in various ligaments. Thus, the quantity and distribution of mechanoreceptors may be related to ligament's function.
Collapse
|
7
|
Changes in mechanoreceptors in rabbits’ anterior cruciate ligaments with age. J Mol Histol 2019; 50:229-237. [DOI: 10.1007/s10735-019-09820-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
|