The Innervation of the Human Acetabular Labrum and Hip Joint: an Anatomic Study

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2014 Feb 18

PMID 24529033

Citations 20

Authors

Abdullah Alzaharani

Kamal Bali

Ravi Gudena

Pamela Railton

Dragana Ponjevic

John R Matyas

James N Powell

Affiliations

Soon will be listed here.

Abstract

Background: The aim of the current study was to evaluate the innervation of the acetabular labrum in the various zones and to understand its potential role in nociception and proprioception in hips with labral pathology.

Methods: A total of twenty hip labrums were tagged and excised intraoperatively from patients undergoing a total hip replacement. After preparation, the specimens were cut to a thickness of 10 μm and divided into four quadrants (zones) using a clock face pattern. Neurosensory structure distribution was then evaluated using Hematoxylin and Eosin (H and E), and immunoreactivity to S-100.

Results: All specimens had abundant free nerve endings (FNEs). These were seen predominantly superficially and on the chondral side of the labrum. In addition, predominantly three different types of nerve end organs (NEOs) were identified in all twenty specimens. FNEs and NEOs were more frequently seen in the antero-superior and postero-superior zones. Four specimens had abundant vascularity and disorganised architecture of FNEs in the deeper zones of the antero-superior quadrant suggestive of a healed tear. Myofibroblasts were present in abundance in all the labral specimens and were distributed uniformly throughout all labral zones and depth.

Conclusions: The current study shows that the human acetabular labrum has abundant FNEs and NEOs. These are more abundant in the antero-superior and postero-superior zones. The labrum, by virtue of its neural innervation, can potentially mediate pain as well as proprioception of the hip joint, and be involved in neurosecretion that can influence connective tissue repair.

Citing Articles

Bibliometric analysis of the acetabular labrum.

Zou Z, Tian K, Hooblal A, Wagner T, Zhang W Medicine (Baltimore). 2024; 103(26):e38730.

PMID: 38941388 PMC: 11466121. DOI: 10.1097/MD.0000000000038730.

Basics of hip arthroscopy: Step-by-step technique.

Gursoy S, Cirdi Y, Kirac M, Chahla J J Exp Orthop. 2024; 11(2):e12021.

PMID: 38617136 PMC: 11015078. DOI: 10.1002/jeo2.12021.

Expression of Acetabular Labral Vascular Endothelial Growth Factor and Nerve Growth Factor Is Directly Associated with Hip Osteoarthritis Pain: Investigation by Immunohistochemical Staining.

Sato Y, Tetsunaga T, Yamada K, Kawamura Y, Yoshida A, Ozaki T Int J Mol Sci. 2023; 24(3).

PMID: 36769248 PMC: 9918145. DOI: 10.3390/ijms24032926.

Comparison of early outcomes of arthroscopic labral repair or debridement : a study using the UK Non-Arthroplasty Hip Registry dataset.

Holleyman R, Lyman S, Bankes M, Board T, Conroy J, McBryde C Bone Jt Open. 2022; 3(4):291-301.

PMID: 35369718 PMC: 9044091. DOI: 10.1302/2633-1462.34.BJO-2022-0003.R1.

The Application of Arthroscopic Techniques in the Diagnosis and Treatment of Hip-Related Conditions in China.

Zhao F, Dong H, Huang H, Gao G, Wu R, Shi Y Orthop Surg. 2021; 13(6):1697-1706.

PMID: 34351067 PMC: 8523768. DOI: 10.1111/os.13043.

References

Shirai C, Ohtori S, Kishida S, Harada Y, Moriya H . The pattern of distribution of PGP 9.5 and TNF-alpha immunoreactive sensory nerve fibers in the labrum and synovium of the human hip joint. Neurosci Lett. 2008; 450(1):18-22. DOI: 10.1016/j.neulet.2008.11.016. View

Petersen W, Petersen F, Tillmann B . Structure and vascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. Arch Orthop Trauma Surg. 2003; 123(6):283-8. DOI: 10.1007/s00402-003-0527-7. View

Zaltz I . The biomechanical case for labral débridement. Clin Orthop Relat Res. 2012; 470(12):3398-405. PMC: 3492648. DOI: 10.1007/s11999-012-2446-9. View

Day B, Mackenzie W, Shim S, Leung G . The vascular and nerve supply of the human meniscus. Arthroscopy. 1985; 1(1):58-62. DOI: 10.1016/s0749-8063(85)80080-3. View

Seldes R, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald Jr R . Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res. 2001; (382):232-40. DOI: 10.1097/00003086-200101000-00031. View

Kelly B, Williams 3rd R, Philippon M . Hip arthroscopy: current indications, treatment options, and management issues. Am J Sports Med. 2003; 31(6):1020-37. DOI: 10.1177/03635465030310060701. View

Putz R, Schrank C . [Anatomy of the labro-capsular complex]. Orthopade. 1998; 27(10):675-80. DOI: 10.1007/s001320050286. View

Ueo T, Suzuki S, Iwasaki R, Yosikawa J . Rupture of the labra acetabularis as a cause of hip pain detected arthroscopically, and partial limbectomy for successful pain relief. Arthroscopy. 1990; 6(1):48-51. DOI: 10.1016/0749-8063(90)90097-w. View

Salo P, Bray R, Seerattan R, Reno C, McDougall J, Hart D . Neuropeptides regulate expression of matrix molecule, growth factor and inflammatory mediator mRNA in explants of normal and healing medial collateral ligament. Regul Pept. 2007; 142(1-2):1-6. DOI: 10.1016/j.regpep.2007.01.001. View

10.

Wyss T, Clark J, Weishaupt D, Notzli H . Correlation between internal rotation and bony anatomy in the hip. Clin Orthop Relat Res. 2007; 460:152-8. DOI: 10.1097/BLO.0b013e3180399430. View

11.

Byrd J, Jones K . Hip arthroscopy in athletes. Clin Sports Med. 2001; 20(4):749-61. View

12.

Jester J, Petroll W, Barry P, Cavanagh H . Expression of alpha-smooth muscle (alpha-SM) actin during corneal stromal wound healing. Invest Ophthalmol Vis Sci. 1995; 36(5):809-19. View

13.

Gerhardt M, Johnson K, Atkinson R, Snow B, Shaw C, Brown A . Characterisation and classification of the neural anatomy in the human hip joint. Hip Int. 2012; 22(1):75-81. DOI: 10.5301/HIP.2012.9042. View

14.

Kelly B, Shapiro G, DiGiovanni C, Buly R, Potter H, Hannafin J . Vascularity of the hip labrum: a cadaveric investigation. Arthroscopy. 2005; 21(1):3-11. DOI: 10.1016/j.arthro.2004.09.016. View

15.

Kim Y, Azuma H . The nerve endings of the acetabular labrum. Clin Orthop Relat Res. 1995; (320):176-81. View

16.

Beck M, Kalhor M, Leunig M, Ganz R . Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg Br. 2005; 87(7):1012-8. DOI: 10.1302/0301-620X.87B7.15203. View

17.

Tibor L, Leunig M . The pathoanatomy and arthroscopic management of femoroacetabular impingement. Bone Joint Res. 2013; 1(10):245-57. PMC: 3626254. DOI: 10.1302/2046-3758.110.2000105. View

18.

Hosokawa O . [HISTOLOGICAL STUDY ON THE TYPE AND DISTRIBUTION OF THE SENSORY NERVE ENDINGS IN HUMAN HIP JOINT CAPSULE AND LIGAMENT]. Nihon Seikeigeka Gakkai Zasshi. 1964; 38:887-901. View

19.

ALTENBERG A . Acetabular labrum tears: a cause of hip pain and degenerative arthritis. South Med J. 1977; 70(2):174-5. View

20.

Tomasek J, Gabbiani G, Hinz B, Chaponnier C, Brown R . Myofibroblasts and mechano-regulation of connective tissue remodelling. Nat Rev Mol Cell Biol. 2002; 3(5):349-63. DOI: 10.1038/nrm809. View