A Comparative Immunohistochemical and Quantitative Study of the Epiligament of the Medial Collateral and Anterior Cruciate Ligament in Rat Knee

Iliev, Alexandar; Kotov, Georgi; Stamenov, Nikola; Landzhov, Boycho; Kirkov, Vidin; Georgiev, G

doi:10.4067/s0717-95022021000100151

Cited by 3 publications

(10 citation statements)

References 18 publications

(29 reference statements)

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“…They finally concluded due to the ultrastructural characteristics that fibroblasts might be involved in differentiation, phagocytosis, and collagen synthesis; the authors also hypothesized that single collagen fibers or those grouped in bundles may respond to ligament tension in different directions [ 8 , 21 ]. With the aim of obtaining more detailed knowledge of the MCL and ACL ELs and comparing it in rats, Iliev et al [ 32 ] found a statistically significant difference in the number of cells per mm 2 in the EL of the two ligaments, with a greater number in the MCL. Furthermore, the EL contains an abundance of blood vessels and sensory/proprioceptive nerve elements, which form a complex network [ 6 – 8 , 11 , 12 , 18 – 20 , 33 ].…”

Section: Introductionmentioning

confidence: 99%

“…Their recent studies [ 12 , 18 , 19 ] of MCL injury models have revealed that the fibroblasts in the EL are not static but are responsible for synthesizing various types of collagen, matrix metalloproteinases, decorin, fibronectin, and fibromodulin. All these molecules are implicated in the degradation, proliferation, and remodeling of the ligament after trauma [ 12 , 18 , 19 , 32 ].…”

Section: Introductionmentioning

confidence: 99%

“…Ligaments are hypocellular and hypovascular structures built of dense regular connective tissue [29–31]. Collagen is the most widespread extracellular component of soft connective tissue and is the major tensile‐bearing element [6, 7, 31, 32]. The endoligament is sheath of connective tissue that covers the collagen fibers in the ligament proper, which are organized into fascicles [6–8, 11, 12, 22, 33].…”

Section: Introductionmentioning

confidence: 99%

“…The endoligament is sheath of connective tissue that covers the collagen fibers in the ligament proper, which are organized into fascicles [6–8, 11, 12, 22, 33]. Collagen constitutes approximately 75% of the dry weight of ligaments, the predominant type being type I, which accounts for nearly 85% of the total collagen of ligaments and is chiefly responsible for their tensile strength [6, 7, 32, 34]. The remaining 15% includes types III, V, VI, XI, and XIV [34].…”

Section: Introductionmentioning

confidence: 99%

“…The collagen fibrils in the EL mainly comprise collagen types III and V [6, 7, 9, 22, 32]. Collagen type III is integral to ligament repair [9, 30, 34].…”

Section: Introductionmentioning

confidence: 99%

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The novel epiligament theory: differences in healing failure between the medial collateral and anterior cruciate ligaments

et al. 2022

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According to current literature, 90% of knee ligament injuries involve the medial collateral ligament or the anterior cruciate ligament. In contrast to the medial collateral ligament, which regenerates relatively well, the anterior cruciate ligament demonstrates compromised healing. In the past, there were numerous studies in animal models that examined the healing process of these ligaments, and different explanations were established. Although the healing of these ligaments has been largely investigated and different theories exist, unanswered questions persist.Therefore, the aim of this article is 1) to review the different historical aspects of healing of the medial collateral ligament and present the theories for healing failure of the anterior cruciate ligament; 2) to examine the novel epiligament theory explaining the medial collateral ligament healing process and failure of anterior cruciate ligament healing; and 3) to discuss why the enveloping tissue microstructure of the aforementioned ligaments needs to be examined in future studies.We believe that knowledge of the novel epiligament theory will lead to a better understanding of the normal healing process for implementing optimal treatments, as well as a more holistic explanation for anterior cruciate ligament healing failure.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…The collagen fibrils in the EL mainly comprise collagen types III and V [6, 7, 9, 22, 32]. Collagen type III is integral to ligament repair [9, 30, 34].…”

Section: Introductionmentioning

confidence: 99%

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The novel epiligament theory: differences in healing failure between the medial collateral and anterior cruciate ligaments

et al. 2022

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A comparative study of the epiligament of the medial collateral and anterior cruciate ligaments in the human knee: Immunohistochemical analysis of CD 34, α-smooth muscle actin and vascular endothelial growth factor in relation to epiligament theory

Георгиев

Tubbs²,

Olewnik³

et al. 2022

The Knee

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Are There Any Differences in the Healing Capacity between the Medial Collateral Ligament’s (MCL) Proximal and Distal Parts in the Human Knee? Quantitative and Immunohistochemical Analysis of CD34, α-Smooth Muscle Actin (α-SMA), and Vascular Endothelial Growth Factor (VEGF) Expression Regarding the Epiligament (EL) Theory

Georgiev,

Yordanov,

Gaydarski

et al. 2024

Biomedicines

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The human knee is a complex joint that comprises several ligaments, including the medial collateral ligament (MCL). The MCL provides stability to the knee and helps prevent its excessive inward movement. The MCL also has a thin layer of connective tissue known as the epiligament (EL), which adheres to the ligament. This unique feature has drawn attention in the field of ligament healing research, as it may have implications for the recovery process of MCL injuries. According to the EL theory, ligament regeneration relies heavily on the provision of cells, blood vessels, and molecules. The present study sought to compare the expression of vascular endothelial growth factor (VEGF), CD34, and α-smooth muscle actin (α-SMA) in healthy knees’ proximal and distal MCL segments to better understand how these proteins affect ligament healing. By improving the EL theory, the current results could lead to more effective treatments for ligament injury. To conduct the present analysis, monoclonal antibodies were used against CD34, α-SMA, and VEGF to examine samples from 12 fresh knee joints’ midsubstance MCLs. We identified a higher cell density in the EL than in the ligament connective tissue, with higher cell counts in the distal than in the proximal EL part. CD34 immunostaining was weak or absent in blood vessels and the EL, while α-SMA immunostaining was strongest in smooth muscle cells and the EL superficial layer. VEGF expression was mainly in the blood vessels’ tunica media. The distal part showed more SMA-positive microscopy fields and higher cell density than the proximal part (4735 vs. 2680 cells/mm2). Our study identified CD34, α-SMA, and VEGF expression in the MCL EL, highlighting their critical role in ligament healing. Differences in α-SMA expression and cell numbers between the ligament’s proximal and distal parts may explain different healing capacities, supporting the validity of the EL theory in ligament recovery.

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A Comparative Immunohistochemical and Quantitative Study of the Epiligament of the Medial Collateral and Anterior Cruciate Ligament in Rat Knee

Cited by 3 publications

References 18 publications

The novel epiligament theory: differences in healing failure between the medial collateral and anterior cruciate ligaments

The novel epiligament theory: differences in healing failure between the medial collateral and anterior cruciate ligaments

A comparative study of the epiligament of the medial collateral and anterior cruciate ligaments in the human knee: Immunohistochemical analysis of CD 34, α-smooth muscle actin and vascular endothelial growth factor in relation to epiligament theory

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