Efficacy of immunohistological methods in detecting functionally viable mechanoreceptors in the remnant stumps of injured anterior cruciate ligaments and its clinical importance

Abstract

Immunological methods are more reliable and easier to use as compared with the conventional methods of histological staining for identifying remnant stumps likely to be of some proprioceptive benefit after an ACL injury. Such an identification might help us preserve certain remnant stumps during ACL reconstruction which might in turn improve the postoperative functional outcomes.

Innervation of Partially Inserted Human Tendons Used to Reconstruct Anterior Cruciate Ligament

“…The pattern of innervation of the normal ACL we have observed here basically agrees with previous studies using gold impregnation or immunohistochemical techniques [11,12,14], and also was quite similar to that reported in ACL remnants [17,20]. Perivascular nerves, free nerve endings and two types of identifiable mechanoreceptors, i.e.…”

“…Thus to preserve or to ensure the innervation of the reconstructed ACL should be a main scope of ACR reconstructive surgery [4][5][6]. Sensory innervation is absent from reconstructed ACL [7,21]while innervation has been demonstrated in grafts inserted in ACL remnants [17][18][19][20].…”

“…Nevertheless, this hypothesis is still not supported by clinical findings [15]. In patients with cruciate-retaining total knee arthroplasty mechanoreceptors are present 5 to 12 years later [16], and residual remnants of ruptured ACL contain morphologically normal mechanoreceptors and proprioceptive fibbers evenly distributed at both tibial and femoral attachments in one third of the cases [17][18][19][20]. Conversely, other researchers reported the absence of mechanoreceptors in biopsy samples of ACL after reconstruction with Achilles allografts (1 to 10 years), and absence of sensory function after ACL re-construction, presumably because the ACL grafts were not reinnervated [7,21].…”

Proprioception in musculoskeletal rehabilitation. Part 1: Basic science and principles of assessment and clinical interventions

“…Trauma, here referred to a single known event that causes physical injury (van Mechelen, Hlobil et al 1992), frequently presents with disruption of musculoskeletal tissues and concurrent damage or destruction of mechanoreceptors innervating those tissues (Dhillon, Bali et al 2010, Bali, Dhillon et al 2012. Following trauma, and after pain and swelling have resolved, the loss of musculoskeletal tissue and its mechanoreceptors is associated with persistent M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 6 impairment of proprioception (Smith and Brunolli 1989, Borsa, Lephart et al 1997, Willems, Witvrouw et al 2002.…”

Re-Tensioning Technique to Cover the Graft With Remnant in Anterior Cruciate Ligament Reconstruction

“…Preserving the remnant of the ruptured ACL might have some advantages such as preservation of proprioceptive function 8 ; enhancement of the revascularization process 9 ; reduced synovial fluid leakage, which may cause tunnel enlargement 10 ; and mechanical protection of the graft from being scratched by the intercondylar notch. In the traditional ACL reconstruction technique, the ACL remnant is usually removed to some extent for the purpose of positioning the femoral and tibial tunnels accurately.…”