-

Öz

Amaç: Klasik literatürde labrum ve transvers asetabular ligament (TAL), bol miktarda mekanoreseptör ve serbest sinir lifleri içeren özel anatomic yapılar olarak tanımlanmıştır. Eklemi derinleştirirler ve çıkığa karşı doğal bir bariyer vazifesini üstlenerek stabiliteye katkıda bulunurlar. Hipotezimize göre, ciddi koksartroz labrum ve TAL’daki mekanoreseptörleri yok etmektedir. Bu çalışmanın amacı, labrum ve TAL’ın nörolojik yapısını immünohistokimyasal analizle inceleyerek söz konusu yapıların mikroskopik anatomisini değerlendirmektir.Çalışma planı: Koksartroz nedeniyle total kalça artroplastisi yapılan ardışık otuz beş hastanın kalçalarından dörder numune halinde labrum ve TAL örnekleri diseke edilmiştir. Formaldehitle tespit edilen örnekler, Mihalko tarafından tanımlanan immünohistokimyasal analiz yöntemiyle mekanoreseptör ve serbest sinir ucu varlığı yönünden değerlendirilmiştir.Bulgular: TAL örneklerinde mekanoreseptör bulunamamış olup, labrum ve TAL’da fibröz bağ dokusunun iyi damarlanmış olduğu ve bolca serbest sinir ucu içerdiği gözlenmiştir (sırasıyla ortalama 2.6 duyu lifi/hpf ve 3.1 duyu lifi/hpf ). Labrumda ortalama 2.3 mekanoreseptör/hpf bulunmakta olup, mekanoreseptör yoğunluğu değerlendirildiğinde labrum ve TAL arasında keskin bir fark bulunmaktadır.Çıkarımlar: Bu çalışmadaki bulgular, TAL’ın mekanoreseptörden yoksun olduğunu göstermektedir. Ancak, TAL ve labrumda bulunan serbest sinir uçlarının, kalça ağrısının oluşumunda potansiyel bir rolü olduğunu düşündürmektedir

Anahtar Kelimeler

• Koksartroz; labrum; mekanoreseptör; transvers asetabular ligament

Immunohistochemical analysis of mechanoreceptors in transverse acetabular ligament and labrum: a prospective analysis of 35 cases

Abstract

Objective: The labrum and transverse acetabular ligament (TAL) are classically described as distinct anatomical structures with abundant mechanoreceptors and free nerve fibers. They deepen the joint and act as natural barriers against dislocation, thus providing additional stability. We hypothesized that severe coxarthrosis leads to elimination of labrum and TAL mechanoreceptors. This study evaluated the microscopic anatomy of the labrum and TAL and specifically investigated the neurological status of these structures.
Methods: Labral and TAL specimens from 35 consecutive patients with coxarthrosis undergoing total hip arthroplasty were dissected into a total of 4 specimens per hip. Formaldehyde-fixed specimens were evaluated for the presence of mechanoreceptors and free nerve endings by neurofilament protein and S-100 protein immunohistochemistry and microscopy.
Results: Mechanoreceptors were identified in the labral (2.3/high power field) but not TAL specimens, with a sharp delineation between the tissues. In contrast, both labrum and TAL showed good vascularity with abundant free nerve fibers within fibrous connective tissue (mean, 2.6 sensory fibers/high power field vs 3.1/high power field, respectively).
Conclusion: This study demonstrated that the TAL lacks mechanoreceptors. However, TAL and labrum free nerve fibers suggest potential roles as hip pain generators.

Keywords

• Coxarthrosis
• labrum
• mechanoreceptors
• transverse acetabular ligament

References

1. Kean WF, Kean R, Buchanan WW. Osteoarthritis: symp- toms, signs and source of pain. Inflammopharmacology 2004;12:3–31.
2. 2 Arnoldi CC, Linderholm H, Müssbichler H. Venous en- gorgement and intraosseous hypertension in osteoarthritis of the hip. J Bone Joint Surg Br 1972;54:409–21.
3. Phillips RS, Bulmer JH, Hoyle G, Davies W. Venous drainage in osteoarthritis of the hip. A study after oste- otomy. J Bone Joint Surg Br 1967;49:301–9.
4. Cavalcante ML, Rodrigues CJ, Mattar R Jr. Mechanore- ceptors and nerve endings of the triangular fibrocartilage in the human wrist. J Hand Surg Am 2004;29:432–8.
5. Moraes MR, Cavalcante ML, Leite JA, Ferreira FV, Castro AJ, Santana MG. Histomorphometric evaluation of mech- anoreceptors and free nerve endings in human lateral ankle ligaments. Foot Ankle Int 2008;29:87–90.
6. Morisawa Y. Morphological study of mechanoreceptors on the coracoacromial ligament. J Orthop Sci 1998;3:102–10.
7. Freeman MA, Wyke B. The innervation of the knee joint. An anatomical and histological study in the cat. J Anat 1967;101(Pt 3):505–32.
8. Delgado-Baeza E, Utrilla-Mainz V, Contreras-Porta J, Santos-Alvarez I, Martos-Rodríguez A. Mechanorecep- tors in collateral knee ligaments: an animal experiment. Int Orthop 1999;23:168–71.

9. He XH, Tay SS, Ling EA. Sensory nerve endings in mon- key hip joint capsule: a morphological investigation. Clin Anat 1998;11:81–5.
10. Rossi A, Grigg P. Characteristics of hip joint mechanore- ceptors in the cat. J Neurophysiol 1982;47:1029–42.
11. Carli G, Farabollini F, Fontani G, Meucci M. Slowly adapt- ing receptors in cat hip joint. J Neurophysiol 1979;42:767– 78.
12. Moraes MR, Cavalcante ML, Leite JA, Macedo JN, Sam- paio ML, Jamacaru VF, et al. The characteristics of the mechanoreceptors of the hip with arthrosis. J Orthop Surg Res 2011;6:58.
13. Franchi A, Zaccherotti G, Aglietti P. Neural system of the human posterior cruciate ligament in osteoarthritis. J Ar- throplasty 1995;10:679–82.
14. Stubbs G, Dahlstrom J, Papantoniou P, Cherian M. Cor- relation between macroscopic changes of arthrosis and the posterior cruciate ligament histology in the osteoarthritic knee. ANZ J Surg 2005;75:1036–40.
15. Jain S, Aderinto J, Bobak P. The role of the transverse ac- etabular ligament in total hip arthroplasty. Acta Orthop Belg 2013;79:135–40.
16. Gerhardt M, Johnson K, Atkinson R, Snow B, Shaw C, Brown A, et al. Characterisation and classification of the neural anatomy in the human hip joint. Hip Int 2012;22:75–81.
17. Bali K, Dhillon MS, Vasistha RK, Kakkar N, Chana R, Prabhakar S. Efficacy of immunohistological methods in detecting functionally viable mechanoreceptors in the rem- nant stumps of injured anterior cruciate ligaments and its clinical importance. Knee Surg Sports Traumatol Arthrosc 2012;20:75–80.
18. Mihalko WM, Creek AT, Mary MN, Williams JL, Kom- atsu DE. Mechanoreceptors found in a posterior cruciate ligament from a well-functioning total knee arthroplasty retrieval. J Arthroplasty 2011;26:504.e9–12.
19. Zimny ML. Mechanoreceptors in articular tissues. Am J Anat 1988;182:16–32.
20. Johansson H, Sjölander P, Sojka P. Receptors in the knee joint ligaments and their role in the biomechanics of the joint. Crit Rev Biomed Eng 1991;18:341–68.
21. Hogervorst T, Brand RA. Mechanoreceptors in joint func- tion. J Bone Joint Surg Am 1998;80:1365–78.
22. Vangsness CT Jr, Ennis M, Taylor JG, Atkinson R. Neural anatomy of the glenohumeral ligaments, labrum, and sub- acromial bursa. Arthroscopy 1995;11:180-4.
23. Kim YT, Azuma H. The nerve endings of the acetabular labrum. Clin Orthop Relat Res 1995;320:176–81.
24. Assimakopoulos AP, Katonis PG, Agapitos MV, Exarchou EI. The innervation of the human meniscus. Clin Orthop Relat Res 1992;275:232–6.
25. Archbold HA, Mockford B, Molloy D, McConway J, Ogonda L, Beverland D. The transverse acetabular liga- ment: an aid to orientation of the acetabular component during primary total hip replacement: a preliminary study of 1000 cases investigating postoperative stability. J Bone Joint Surg Br 2006;88:883–6.
26. Jain S, Aderinto J, Bobak P. The role of the transverse ac- etabular ligament in total hip arthroplasty. Acta Orthop Belg 2013;79:135–40.
27. Epstein NJ, Woolson ST, Giori NJ. Acetabular compo- nent positioning using the transverse acetabular ligament: can you find it and does it help? Clin Orthop Relat Res 2011;469:412–6.
28. Kalteis T, Sendtner E, Beverland D, Archbold PA, Hube R, Schuster T, et al. The role of the transverse acetabular ligament for acetabular component orientation in total hip replacement: an analysis of acetabular component position and range of movement using navigation software. J Bone Joint Surg Br 2011;93:1021–6.
29. 29 Miyoshi H, Mikami H, Oba K, Amari R. Anteversion of the acetabular component aligned with the transverse ac- etabular ligament in total hip arthroplasty. J Arthroplasty 2012;27:916–22.