Immunohistological Evaluation of Proprioceptive Potential of the Residual Stump of Injured Anterior Cruciate Ligaments (ACL)

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2010 Feb 6

PMID 20135121

Citations 46

Authors

Mandeep S Dhillon

Kamal Bali

R K Vasistha

Affiliations

Soon will be listed here.

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.

Citing Articles

Comparison of Dynamic Postural Stability in Autografts Versus Allografts Following Anterior Cruciate Ligament Reconstruction With Remnant Preservation: A Prospective Study With 1-Year Follow-up.

Rhim H, Lee J, Lee S, Kang C, Han S, Jang K Orthop J Sports Med. 2025; 13(1):23259671241303752.

PMID: 39839982 PMC: 11748150. DOI: 10.1177/23259671241303752.

Occurrence Rate of Cyclops Lesion After Anatomic Double-Bundle ACL Reconstruction: Comparison Between Remnant Tissue Preservation and Resection Methods.

Hishimura R, Kondo E, Suzuki Y, Matsuoka M, Iwasaki K, Onodera T Orthop J Sports Med. 2022; 10(10):23259671221130688.

PMID: 36324698 PMC: 9620259. DOI: 10.1177/23259671221130688.

Clinical outcomes in stump-preserving versus stump-sacrificing anterior cruciate ligament reconstruction; a randomized controlled study.

El-Desouky M, Ezzat M, Abdelrazek B BMC Musculoskelet Disord. 2022; 23(1):703.

PMID: 35870924 PMC: 9308271. DOI: 10.1186/s12891-022-05665-3.

Mechanoreceptor analysis on femoral and tibial site remnant of anterior cruciate ligament injury using immunohistochemistry.

Adriansyah D, Santoso A, Sibarani T, Setyawan N Ann Med Surg (Lond). 2022; 78:103849.

PMID: 35734679 PMC: 9207111. DOI: 10.1016/j.amsu.2022.103849.

Risk factors of young males with physically demanding occupations having accumulated damage of anterior cruciate ligament.

Yu W, Xianmin L, Liangbi X, Chunbao L Orthop Surg. 2022; 14(6):1109-1114.

PMID: 35478322 PMC: 9163968. DOI: 10.1111/os.13276.

References

Fromm B, Kummer W . 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. 1994; 2(2):118-22. DOI: 10.1007/BF01476484. View

Paterson F, Trickey E . Anterior cruciate ligament reconstruction using part of the patellar tendon as a free graft. J Bone Joint Surg Br. 1986; 68(3):453-7. DOI: 10.1302/0301-620X.68B3.3733814. View

Schutte M, Dabezies E, Zimny M, Happel L . Neural anatomy of the human anterior cruciate ligament. J Bone Joint Surg Am. 1987; 69(2):243-7. View

Barrett D . Proprioception and function after anterior cruciate reconstruction. J Bone Joint Surg Br. 1991; 73(5):833-7. DOI: 10.1302/0301-620X.73B5.1894677. View

Schultz R, Miller D, Kerr C, Micheli L . Mechanoreceptors in human cruciate ligaments. A histological study. J Bone Joint Surg Am. 1984; 66(7):1072-6. View

Ochi M, Iwasa J, Uchio Y, Adachi N, Sumen Y . The regeneration of sensory neurones in the reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br. 1999; 81(5):902-6. DOI: 10.1302/0301-620x.81b5.9202. View

Recht M, Piraino D, Cohen M, Parker R, Bergfeld J . Localized anterior arthrofibrosis (cyclops lesion) after reconstruction of the anterior cruciate ligament: MR imaging findings. AJR Am J Roentgenol. 1995; 165(2):383-5. DOI: 10.2214/ajr.165.2.7618562. View

Georgoulis A, Pappa L, Moebius U, Malamou-Mitsi V, Pappa S, Papageorgiou C . The presence of proprioceptive mechanoreceptors in the remnants of the ruptured ACL as a possible source of re-innervation of the ACL autograft. Knee Surg Sports Traumatol Arthrosc. 2001; 9(6):364-8. DOI: 10.1007/s001670100240. View

Bonci C . Assessment and evaluation of predisposing factors to anterior cruciate ligament injury. J Athl Train. 2006; 34(2):155-64. PMC: 1322905. View

10.

Denti M, Monteleone M, Berardi A, Panni A . Anterior cruciate ligament mechanoreceptors. Histologic studies on lesions and reconstruction. Clin Orthop Relat Res. 1994; (308):29-32. View

11.

Del Valle M, Harwin S, Maestro A, Murcia A, Vega J . Immunohistochemical analysis of mechanoreceptors in the human posterior cruciate ligament: a demonstration of its proprioceptive role and clinical relevance. J Arthroplasty. 1999; 13(8):916-22. DOI: 10.1016/s0883-5403(98)90199-1. View

12.

Borsa P, Lephart S, Irrgang J, Safran M, Fu F . The effects of joint position and direction of joint motion on proprioceptive sensibility in anterior cruciate ligament-deficient athletes. Am J Sports Med. 1997; 25(3):336-40. DOI: 10.1177/036354659702500311. View

13.

Zimny M, Schutte M, Dabezies E . Mechanoreceptors in the human anterior cruciate ligament. Anat Rec. 1986; 214(2):204-9. DOI: 10.1002/ar.1092140216. View

14.

McDaniel Jr W, DAMERON Jr T . The untreated anterior cruciate ligament rupture. Clin Orthop Relat Res. 1983; (172):158-63. View

15.

Mayr H, Weig T, Plitz W . Arthrofibrosis following ACL reconstruction--reasons and outcome. Arch Orthop Trauma Surg. 2004; 124(8):518-22. DOI: 10.1007/s00402-004-0718-x. View

16.

Johansson H, Sjolander P, Sojka P . Receptors in the knee joint ligaments and their role in the biomechanics of the joint. Crit Rev Biomed Eng. 1991; 18(5):341-68. View

17.

Noyes F, Butler D, Paulos L, Grood E . Intra-articular cruciate reconstruction. I: Perspectives on graft strength, vascularization, and immediate motion after replacement. Clin Orthop Relat Res. 1983; (172):71-7. View

18.

Krauspe R, Schmitz F, Zoller G, Drenckhahn D . Distribution of neurofilament-positive nerve fibres and sensory endings in the human anterior cruciate ligament. Arch Orthop Trauma Surg. 1995; 114(4):194-8. DOI: 10.1007/BF00444261. View

19.

Arnoczky S, Tarvin G, Marshall J . Anterior cruciate ligament replacement using patellar tendon. An evaluation of graft revascularization in the dog. J Bone Joint Surg Am. 1982; 64(2):217-24. View

20.

Parsch D, Fromm B, Kummer W . [Projections and fiber characteristics of sensory afferents of the anterior cruciate ligament in an animal experiment]. Unfallchirurgie. 1996; 22(5):193-201. DOI: 10.1007/BF02641220. View