Histopathological analysis of the posterior cruciate ligament in primary osteoarthritis

Martins, Glaucus Cajaty; Camanho, Gilberto Luís; Rodrigues, Mara Ibis; Filho, Luiz Felippe Martins; Demange, Marco Kawamura

doi:10.1007/s00590-018-2136-8

Cited by 10 publications

(10 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, mucoid degeneration of the PCL is reportedly associated with degeneration of the ACL. 17 , 18 In addition, some authors have stated that retention of the PCL should not be recommended in the treatment of severe OA because of architectural and functional damage to the PCL, including mucoid degeneration. 19 , 20 In fact, the pathological examination in our patients revealed that the mucoid degenerative ligaments had lost their normal fiber structure, which had been replaced by collagen fibers.…”

Section: Discussionmentioning

confidence: 99%

Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration

et al. 2022

View full text Add to dashboard Cite

Magnetic resonance imaging (MRI) findings of a tram-track appearance and celery stalk appearance in mucoid degeneration of the cruciate ligament are valuable; however, their pathological basis is unclear. Because these appearances are generally seen throughout the entire ligament, the association between MRI findings and pathological findings must be verified in specimens of the whole degenerated ligament, including the ligamentous attachments to bone. We herein report two cases of mucoid degeneration of the posterior cruciate ligament with osteoarthritis of the knee requiring total knee arthroplasty. The entire degenerated ligament, including the ligamentous attachments to bone, was removed and pathologically evaluated. On pathological examination, the central portion of the lesion showed typical mucoid degeneration, whereas the marginal and adherent portions showed normal ligament tissue, consistent with a tram-track appearance on T2-weighted MRI. The fibrous normal ligament tissues in the longitudinal direction in regions of mucoid degeneration were consistent with a celery stalk appearance on T2-weighted MRI. No mucoid degeneration was found in the attachment area. The tram-track appearance and celery stalk appearance of mucoid degeneration on MRI can be explained by the pathological findings.

show abstract

Section: Discussionmentioning

confidence: 99%

Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Arthroplasty with PCL preservation demands not only a structural preservation of the ligament, but also functional preservation of its proprioceptive capacity. 18,21 Nelisen et al 23 in their study proposes that the mucoid degeneration of the PCL mirrors the radiological arthritic status of the knee and advocates the use of PS implant in knees with advanced stages of arthritis even when the PCL is clinically intact. Allain et al 21 and Albert et al 22 in their studies reached the same conclusion that there was a higher incidence of degeneration in PCL in patients who had ACL degeneration.…”

Section: Discussionmentioning

confidence: 99%

“…This collagen disorganisation and loss of integrity of the ligaments have been found to alter the functionality of the ligaments in significant animal studies. 16,17 A study of histopathological analysis of the PCL by Martins et al 18 in 2018 showed only a small percentage of patients with advanced arthritis retained PCL with a functional neurovascular bundle.…”

Section: Mucoid Degeneration Of Pclmentioning

confidence: 99%

Incidence of Mucoid Degeneration of Cruciate Ligaments in Patients Undergoing Primary Total Knee Replacements – A Study of 42 Knees

Rajanish

Harisankar

Malayil

et al. 2020

KJOrth

View full text Add to dashboard Cite

Mucoid degeneration of the ACL is largely an underdiagnosed condition. These are often misjudged as partial tears of ACL on routine MRI evaluation. Here we histologically analyse the incidence of mucoid degeneration of the cruciate ligaments in 32 patients who underwent primary total knee arthroplasty in our institute. 10 among them had bilateral total knee replacements making the total sample size 42 knees. ACL samples were sent for histopathological evaluation from 41 knees (one knee was an ACL deficient knee), and PCL samples were sent from patients who underwent total knee replacements with posterior stabilising implants. out of these 41 samples of ACL, 60.9 % turned out to be positive for mucoid degeneration. 9 out of 13 PCL samples (69.5%) turned out to be having mucoid degeneration. This study shows that the real incidence of mucoid degeneration of cruciate ligaments is much more than what is reported in literature. This emphasises the role of preoperative MRI to look for coexisting painful mucoid degeneration even in elderly patients with early osteoarthritis, which is an arthroscopically treatable condition thus delaying the total knee replacements in these patients. The higher incidence of mucoid degeneration in cruciate ligaments associated with advanced arthritis raises the question of functional integrity of PCL in these patients, making the use of posterior stabilising implants more advisable in patients with advanced stages of osteoarthritis.

show abstract

“…The sections were stained with Safranin-O fast-green and evaluated microscopically. We evaluated the specimens at 100× in the examination of ten fields according to the method described in previous studies [9]. The grade of collagen fiber impairment was classified as follows: mild, impairment of less than 20% of the collagen fibers; moderate, impairment of at least 20% and less than 50% of the collagen fibers; and severe impairment of more than 50% of the collagen fibers (Fig.…”

Section: Microscopic Analysis Of Pclsmentioning

confidence: 99%

The evaluation of degeneration of posterior cruciate ligament using CT Hounsfield unit in knee osteoarthritis

Sumida

Nakasa

Ishikawa

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background Posterior cruciate ligament (PCL) degeneration is often seen in knee osteoarthritis (OA); however, there is no established method for its evaluation. The purpose of this study is to investigate whether the Hounsfield unit (HU) using computed tomography (CT) could be a useful scale to evaluate the degeneration of PCL in knee OA. Methods Knee OA treated with total knee arthroplasty (21 patients, 21 knees) and non-osteoarthritic knees (21 patients, 21 knees) were retrospectively observed and studied. All PCLs in the knees were analyzed using CT. The PCL in the sagittal section was divided into three regions: proximal, middle, and distal sections. The HU value of the PCL at each area was measured. In osteoarthritic knees, tissues from the PCL were collected and histologically graded. The correlation between the radiological classification by Kellgren and Lawrence and the histological grade was analyzed. The average CT HU values for each degenerative grade were also calculated and compared. Results The HU values in OA and non-OA were 70.7 and 88.4 HU (p < 0.05) at the proximal region, 75.7 and 85.3 HU (p < 0.05) in the central region, and 82.3 and 86.5 HU (p > 0.05) in the distal region, respectively. The degeneration of PCL was graded as follows: one, three, and 17 mild, moderate, and severe cases at the proximal portion, and 16, 4, and one mild, moderate, and severe cases at the distal portion, respectively. The radiological classification and the grade of degeneration were not correlated in either the proximal (r = 0.047, p = 0.84) or the distal (r = − 0.21, p = 0.35) portions. The HU value was 84.5, 72.1, and 70.6 HU for mild, moderate, and severe grades, respectively (mild versus moderate: p < 0.05, mild versus severe: p < 0.05, moderate versus severe: p > 0.05). Conclusions In knee OA, a lower HU value in the PCL indicates the progression of degeneration. The CT HU value could be a useful measurement to predict the grade of PCL degeneration.

show abstract

Histopathological analysis of the posterior cruciate ligament in primary osteoarthritis

Abstract: Basic Science Level IV.

Cited by 10 publications

References 24 publications

Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration

Association between magnetic resonance imaging characteristics and pathological findings in entire posterior cruciate ligament with mucoid degeneration

Incidence of Mucoid Degeneration of Cruciate Ligaments in Patients Undergoing Primary Total Knee Replacements – A Study of 42 Knees

The evaluation of degeneration of posterior cruciate ligament using CT Hounsfield unit in knee osteoarthritis

Contact Info

Product

Resources

About