Histopathological study in acute rupture of the anterior cruciate ligament of the knee.
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Published:
Feb 15, 2018
Keywords:
anterior cruciate ligament, ACL, Histopathology.
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Abstract
IntroductionThe histological structure of the ligaments, including the ACL, is composed of collagen and elastin wrapped in a matrix of water and proteoglycans. Collagen is the main component of tendons and ligaments, accounting for 65-75% of its dry weight. The aim of the present study is performing a histopathological evaluation of the ruptured ACL fragments taken at the time of the surgical procedure by arthroscopy.Material and methodsA prospective observational study of 50 cases with ACL rupture. LCA samples were taken in an arthroscopic procedure and the histopathology of the ligament was evaluated.ResultsThe results are mentioned based on results of pathological anatomy and post-operative evolution.ConclusionDegenerative changes were evidenced in the histopathology that can not be demonstrated if these changes are previous or posterior to the ligament rupture.
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Arzac Ulla, I. R., Burgos, E. T., Reymundez, E., Regazzoni, P., & Ridao, G. (2018). Histopathological study in acute rupture of the anterior cruciate ligament of the knee. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 83(1), 20-24. https://doi.org/10.15417/705
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Clinical Research
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References
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2. Miyasaka KC, Daniel DM, Stone ML, Hirshman P. The incidence of knee ligament injuries in the general population. American Journal of Knee Surgery 1991;4:3-8.
3. Shino K, Oakes BW, Horibe S, Nakata K, Nakamura N. Collagen fibril populations in human anterior cruciate ligament allografts. Electron microscopic analysis. Am J Sports Med 1995 Mar-Apr;23(2):203-8; discussion 209.
4. Gao F, Zhou J, He C, Ding J, Lou Z, Xie Q, Li H, et al. A Morphologic and Quantitative Study of Mechanoreceptors in the Remnant Stump of the Human Anterior Cruciate Ligament. Arthroscopy 2016.
Feb;32(2):273-80. doi: 10.1016/j.arthro.2015.07.010. Epub 2015 Oct 1.
5. Butler DL, Guan Y, Kay MD, Cummings JF, Feder SM, Levy MS. Location-dependent variations in the material properties of the anterior cruciate ligament. J Biomech 1992 25:511–518.
6. Chandrashekar N, Mansouri H, Slauterbeck J, Hashemi J. Sex- based differences in the tensile properties of the human anterior cruciate ligament. J Biomech 2006 39:2943–2950.
7. Suzuki D, Otsubo H, Watanabe T,Kamiya T, Nagoya S, Yamashita T, Shino K. Ultrastructure of the three anterior cruciate ligament bundles. Clin Anat 2015 Oct;28(7):910-6. doi: 10.1002/ca.22586. Epub 2015 Jun 28.
8. Strocchi R, Pasquale V, Gubellini P, Facchini A, Maracci M, Buda R, Zaffagnini S, Ruggeri A. The human anterior cruciate ligament: histological and ultrastructural observations. J Anat 1992 Jun; 180(Pt 3): 515–519.
9. Oka S, Schuhmacher P, Brehmer A, Traut A, Kirsch J, Siebold R. Histological analysis of the tibial anterior cruciate ligament insertion. Knee Surg Sports Traumatol Arthrosc. 2016 Mar;24(3):747-53. doi: 10.1007/s00167-015-3924-x. Epub 2015 Dec 19.
10. Mall NA, Frank RM, Saltzman BM, Cole BJ, Bach BR. Results After Anterior Cruciate Ligament Reconstruction in Patients Older Than 40 Years: How Do They Compare With Younger Patients? A Systematic Review and Comparison With Younger Populations. Sports Health. 2016 Mar-Apr;8(2):177-81.
11. Vaishya R, Kumar Agarwal A, Ingole S, Vijay V. Current Trends in Anterior Cruciate Ligament Reconstruction: A Review. Cureus. 2015 Nov; 7(11): e378.
12. Gwinn DE, Wilckens JH, McDevitt ER, Ross G, Kao TC: The relative incidence of anterior cruciate ligament injury in men and women at the United States Naval Academy. Am J Sports Med. 2000, 28:98–102.
13. Chahla J, Arroquy D, Perez Herrera G, Orlowski B, Guiñazu J, Carboni M, Vilaseca T. Lesión del Ligamento Cruzado Anterior: ¿Es la Disminución en la Movilidad de la Cadera un Factor Predisponente? Artroscopia Vol. 21, No 4 : 121-123 | 2014
14. Uhorchak, J.M., C.R. Scoville, G.N. Williams, R.A. Arciero, P. St Pierre, D.C. Taylor, Risk factors associated with noncontact in- jury of the anterior cruciate ligament: a prospective four-year eval- uation of 859 West Point cadets. Am J Sports Med, 2003. 31(6): p. 831-842.
15. Eiling, E., A. L. Bryant, W. Petersen, A. Murphy, and E. Hohmann, Efects of menstrual-cycle hormone uctuations on musculotendinous sti fness and knee joint laxity. Knee Surg Sports Traumatol Arthrosc, 2007. 15(2): p. 126-132.
16. Iwaki, H., V. Pinskerova, and M.A. Freeman, Tibiofemoral move- ment 1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee. J Bone Joint Surg Br, 2000. 82(8): p. 1189-1195.
17. Meister, K., M.C. Talley, M.B. Horodyski, P.A. Indelicato, J.S. Hartzel, and J. Batts, Caudal slope of the tibia and its relationship to noncontact injuries to the ACL. Am J Knee Surg, 1998. 11(4): p. 217-219.
18. Vaishya R , Hasija R: Joint hypermobility and anterior cruciate ligament injury . J Orthop Surg (Hong Kong). 2013, 21:182–84.
19. Danylchuck, K.D., Finaly, J.B., Krcek J.P. Microstructural organization of human and bovine cruciate ligaments. Clinical Orthopaedics and Related Research. 1978. 131 : 294 - 298.
20. Ho Chen H, Lintner M, Luo Z. Observation of the ultrastructure of anterior cruciate ligament graft by atomic force microscopy. Scanning. 2009 Jan-Feb;31(1):19-23. doi: 10.1002/sca.20137.
21. Bayat, M; Mohammadzade, F; Rakhshan, M. Electron And Light Microscopic Study Of Anterior Cruciate Ligament Of Rabbit. J Anat. Soc. India 2003 52(2) 155-158
22. Dodds J.A. and Arnoczky, S.P. (1994) : Anatomy of the anterior cruciate ligament : a blue print for repair and reconstruction. Arthroscopy. 10(2):132- 139.
23. Simokochi Y, Shultz S. Mechanisms of noncontact anterior cruciate ligament injury. J Athl Train. 2008 Jul-Aug;43(4):396-408. doi: 10.4085/1062-6050-43.4.396.
24. Parry DA, Barnes GR, Craig AS. A comparison of the size distribution of collagen fibrils in connective tissues as a function of age and a possible relation between fibril size distribution and mechanical properties. Proc R Soc Lond B Biol Sci. 1978 Dec 18;203(1152):305-21.
25. Haus BM, Mastrangelo AN, Murray MM. Effect of ante- rior cruciate healing on the uninjured ligament insertion site. J Orthop Res 2012;30:86-94.
2. Miyasaka KC, Daniel DM, Stone ML, Hirshman P. The incidence of knee ligament injuries in the general population. American Journal of Knee Surgery 1991;4:3-8.
3. Shino K, Oakes BW, Horibe S, Nakata K, Nakamura N. Collagen fibril populations in human anterior cruciate ligament allografts. Electron microscopic analysis. Am J Sports Med 1995 Mar-Apr;23(2):203-8; discussion 209.
4. Gao F, Zhou J, He C, Ding J, Lou Z, Xie Q, Li H, et al. A Morphologic and Quantitative Study of Mechanoreceptors in the Remnant Stump of the Human Anterior Cruciate Ligament. Arthroscopy 2016.
Feb;32(2):273-80. doi: 10.1016/j.arthro.2015.07.010. Epub 2015 Oct 1.
5. Butler DL, Guan Y, Kay MD, Cummings JF, Feder SM, Levy MS. Location-dependent variations in the material properties of the anterior cruciate ligament. J Biomech 1992 25:511–518.
6. Chandrashekar N, Mansouri H, Slauterbeck J, Hashemi J. Sex- based differences in the tensile properties of the human anterior cruciate ligament. J Biomech 2006 39:2943–2950.
7. Suzuki D, Otsubo H, Watanabe T,Kamiya T, Nagoya S, Yamashita T, Shino K. Ultrastructure of the three anterior cruciate ligament bundles. Clin Anat 2015 Oct;28(7):910-6. doi: 10.1002/ca.22586. Epub 2015 Jun 28.
8. Strocchi R, Pasquale V, Gubellini P, Facchini A, Maracci M, Buda R, Zaffagnini S, Ruggeri A. The human anterior cruciate ligament: histological and ultrastructural observations. J Anat 1992 Jun; 180(Pt 3): 515–519.
9. Oka S, Schuhmacher P, Brehmer A, Traut A, Kirsch J, Siebold R. Histological analysis of the tibial anterior cruciate ligament insertion. Knee Surg Sports Traumatol Arthrosc. 2016 Mar;24(3):747-53. doi: 10.1007/s00167-015-3924-x. Epub 2015 Dec 19.
10. Mall NA, Frank RM, Saltzman BM, Cole BJ, Bach BR. Results After Anterior Cruciate Ligament Reconstruction in Patients Older Than 40 Years: How Do They Compare With Younger Patients? A Systematic Review and Comparison With Younger Populations. Sports Health. 2016 Mar-Apr;8(2):177-81.
11. Vaishya R, Kumar Agarwal A, Ingole S, Vijay V. Current Trends in Anterior Cruciate Ligament Reconstruction: A Review. Cureus. 2015 Nov; 7(11): e378.
12. Gwinn DE, Wilckens JH, McDevitt ER, Ross G, Kao TC: The relative incidence of anterior cruciate ligament injury in men and women at the United States Naval Academy. Am J Sports Med. 2000, 28:98–102.
13. Chahla J, Arroquy D, Perez Herrera G, Orlowski B, Guiñazu J, Carboni M, Vilaseca T. Lesión del Ligamento Cruzado Anterior: ¿Es la Disminución en la Movilidad de la Cadera un Factor Predisponente? Artroscopia Vol. 21, No 4 : 121-123 | 2014
14. Uhorchak, J.M., C.R. Scoville, G.N. Williams, R.A. Arciero, P. St Pierre, D.C. Taylor, Risk factors associated with noncontact in- jury of the anterior cruciate ligament: a prospective four-year eval- uation of 859 West Point cadets. Am J Sports Med, 2003. 31(6): p. 831-842.
15. Eiling, E., A. L. Bryant, W. Petersen, A. Murphy, and E. Hohmann, Efects of menstrual-cycle hormone uctuations on musculotendinous sti fness and knee joint laxity. Knee Surg Sports Traumatol Arthrosc, 2007. 15(2): p. 126-132.
16. Iwaki, H., V. Pinskerova, and M.A. Freeman, Tibiofemoral move- ment 1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee. J Bone Joint Surg Br, 2000. 82(8): p. 1189-1195.
17. Meister, K., M.C. Talley, M.B. Horodyski, P.A. Indelicato, J.S. Hartzel, and J. Batts, Caudal slope of the tibia and its relationship to noncontact injuries to the ACL. Am J Knee Surg, 1998. 11(4): p. 217-219.
18. Vaishya R , Hasija R: Joint hypermobility and anterior cruciate ligament injury . J Orthop Surg (Hong Kong). 2013, 21:182–84.
19. Danylchuck, K.D., Finaly, J.B., Krcek J.P. Microstructural organization of human and bovine cruciate ligaments. Clinical Orthopaedics and Related Research. 1978. 131 : 294 - 298.
20. Ho Chen H, Lintner M, Luo Z. Observation of the ultrastructure of anterior cruciate ligament graft by atomic force microscopy. Scanning. 2009 Jan-Feb;31(1):19-23. doi: 10.1002/sca.20137.
21. Bayat, M; Mohammadzade, F; Rakhshan, M. Electron And Light Microscopic Study Of Anterior Cruciate Ligament Of Rabbit. J Anat. Soc. India 2003 52(2) 155-158
22. Dodds J.A. and Arnoczky, S.P. (1994) : Anatomy of the anterior cruciate ligament : a blue print for repair and reconstruction. Arthroscopy. 10(2):132- 139.
23. Simokochi Y, Shultz S. Mechanisms of noncontact anterior cruciate ligament injury. J Athl Train. 2008 Jul-Aug;43(4):396-408. doi: 10.4085/1062-6050-43.4.396.
24. Parry DA, Barnes GR, Craig AS. A comparison of the size distribution of collagen fibrils in connective tissues as a function of age and a possible relation between fibril size distribution and mechanical properties. Proc R Soc Lond B Biol Sci. 1978 Dec 18;203(1152):305-21.
25. Haus BM, Mastrangelo AN, Murray MM. Effect of ante- rior cruciate healing on the uninjured ligament insertion site. J Orthop Res 2012;30:86-94.