Immunohistochemical analysis of the neural structures of the posterior cruciate ligament in osteoarthritis patients submitted to total knee arthroplasty: an analysis of thirty-four cases

Abstract

OBJECTIVES:Many authors recommend posterior cruciate ligament-retaining arthroplasty with the intention to maintain the proprioception properties of this ligament. Preservation of the neuroreceptors and nervous fibers may be essential for retaining the proprioception function of the posterior cruciate ligament. The present study was thus developed to evaluate the presence of neural structures in the posterior cruciate ligament resected during posterior stabilized arthroplasty in osteoarthritis patients. In particular, clinical, radiographic and histological parameters were correlated with the presence or absence of neural structures in the posterior cruciate ligament.METHODS:In total, 34 posterior cruciate ligament specimens were stained with hematoxylin-eosin and Gomori trichrome. An immunohistochemical analysis using antibodies against the S100 protein and neurofilaments was also performed. The presence of neural structures was correlated with parameters such as tibiofemoral angulation, histological degeneration of the posterior cruciate ligament, Ahlbäck radiological classification, age, gender and the histologic pattern of the synovial neurovascular bundle around the posterior cruciate ligament.RESULTS:In total, 67.5% of the cases presented neural structures in the posterior cruciate ligament. In 65% of the cases, the neurovascular bundle was degenerated. Nervous structures were more commonly detected in varus knees than in valgus knees (77% versus 50%). Additionally, severe histologic degeneration of the posterior cruciate ligament was related to neurovascular bundle degeneration.CONCLUSIONS:Severe posterior cruciate ligament degeneration was related to neurovascular bundle compromise. Neural structures were more commonly detected in varus knees. Intrinsic neural structures were detected in the majority of the posterior cruciate ligaments of patients submitted to knee arthroplasty for osteoarthritis.

Quantification of Neural Elements in Posterior Cruciate Ligament: Comparison Between Healthy Knees and With Primary Osteoarthrosis

“…Moreno et al, 7 who studied 15 PCLs of cadavers without joint morbidity, did not observe a correlation between the age of the cadaver and the total number of mechanoreceptors. A finding similar to that of Martins, Camanho and Rodrigues, 10 who identified immunomarkers for neural structures in 67.5% of the 34 PCLs of patients with primary OA, but did not observe a correlation between the age of the patients and the presence of neural elements. Colleoni et al, 8 studying a male population of 19 cadavers without joint morbidity, did not observe a significant relationship between the total number of mechanoreceptors and age in the femoral or tibial portions of the PCL.…”

“…[4][5][6] Several studies examined the difference in proprioceptive capacity after the total knee arthroplasty (TKA) and compared the results of several joint reconstruction techniques, particularly the preservation or not of the posterior cruciate ligament (PCL), among other reasons, for believing that this structure has an important proprioceptive function, [4][5][6] being demonstrated and studied the mechanoreceptors in the posterior cruciate ligament of the knee. 2,3,[7][8][9][10][11][12] However, benefits with the preservation of PCL have not been consistently observed. This may be related to a reduction in the population of mechanoreceptors with the advancing age and even faster in OA.…”

Incidence and Risk Factors for Posterior Cruciate Ligament Avulsion during Cruciate Retaining Total Knee Arthroplasty

“…actually preserved, but also the clinical significance of the PCL in TKA. [13][14][15][16][17][18][19] Other recent studies have shown that the presence or absence of the PCL may not affect clinical outcomes in a CR TKA 20 however, late PCL rupture and flexion gap instability remain a source of revision TKA. 21 The incidence and risk factors of PCL avulsion fracture during TKA have not been previously reported.…”

Mechanoreceptors in Remnant Posterior Cruciate Ligament and Achilles Tendon Allografts After Remnant-Preserving Posterior Cruciate Ligament Reconstruction: Hematoxylin-Eosin and Immunohistochemical Assessments

“…Histological investigations of the PCL in osteoarthritic knees have shown degenerative myxoid changes and the presence of all types of mechanoreceptors. 22 In these histological investigations, the presence or absence of specific mechanoreceptor types was examined, or they were evaluated as a percentage area of the staining without an identification of the types of mechanoreceptors. 29 Recently, immunofluorescent and immunohistochemical methods using specific antigen-antibody reactions to detect nerve fibers have presumably produced more reliable and relevant results.…”