Witoński D, Wagrowska-Danielewicz M
Clinic of Orthopaedics, University of Lódź, Poland.
Knee Surg Sports Traumatol Arthrosc. 1999;7(3):177-83. doi: 10.1007/s001670050144.
The etiology of pain in anterior knee pain syndrome is a matter of controversy. The normal, articular cartilage is aneural, so defects in the surface are not thought to produce pain. Some authors have sought the origin of the pain in soft tissue structures around the knee. Knowledge of the distribution of nociceptive nerve fibers around the knee would provide insight for treating anterior knee pain syndrome. Twenty consecutive patients (28 knees), all women, with anterior knee pain syndrome (group I) participated in the study. For comparison we used two groups of patients: 20 patients with an osteoarthritic knee (group II) and 20 patients with anterior cruciate ligament rupture or meniscal lesion with no history of pain in the anterior compartment (group III). Immunohistochemical techniques using a monoclonal antibody to substance-P (SP) were employed to identify nociceptive fibers. For statistical analyses we used the one-way ANOVA test, which was corrected with the LSD test, at the level of significance P < 0.05. Results of the study demonstrate that SP-immunoreactive nerve fibers are widespread within the soft tissues around the knee. These tissues include the retinaculum, synovium, fat pad and, in some circumstances, bone. In cases of anterior knee pain, the presence of neuropeptide-containing fibers was statistically significant in the medial retinaculum (P < 0.005) and in the fat pad (P < 0.001) compared to group III, and compared to group II (P < 0.05 and P < 0.007, respectively). For lateral retinaculum this relationship was not so statistically strong (P < 0.02) and was equal in comparison between anterior knee pain patients (group I) and group II or group III. There were no statistically significant differences in the distribution of substance-P nerve fibers in the fat pad, lateral and medial retinaculum or synovium between groups II and III. The results of this study provide immunohistochemical evidence suggesting that pain may originate in the fat pad and medial retinaculum of many patients with anterior knee pain syndrome.
前膝痛综合征疼痛的病因存在争议。正常的关节软骨无神经，因此表面缺损一般不会引发疼痛。一些作者试图在膝关节周围的软组织结构中寻找疼痛的根源。了解膝关节周围伤害性神经纤维的分布情况，将为治疗前膝痛综合征提供思路。20例连续的前膝痛综合征患者（28个膝关节），均为女性，参与了本研究（I组）。为作比较，我们选取了两组患者：20例骨关节炎患者（II组）和20例前交叉韧带断裂或半月板损伤且无前侧间室疼痛史的患者（III组）。采用针对P物质（SP）的单克隆抗体的免疫组织化学技术来识别伤害性纤维。统计分析采用单因素方差分析，并通过最小显著差法检验校正，显著性水平为P < 0.05。研究结果表明，SP免疫反应性神经纤维广泛分布于膝关节周围的软组织中。这些组织包括支持带、滑膜、脂肪垫，在某些情况下还包括骨骼。在前膝痛病例中，与III组相比，含神经肽纤维在内侧支持带（P < 0.005）和脂肪垫（P < 0.001）中的存在具有统计学意义，与II组相比也具有统计学意义（分别为P < 0.05和P < 0.007）。对于外侧支持带，这种关系在统计学上不那么显著（P < 0.02），在前膝痛患者（I组）与II组或III组之间的比较中无差异。II组和III组之间，脂肪垫、外侧和内侧支持带或滑膜中P物质神经纤维的分布无统计学显著差异。本研究结果提供了免疫组织化学证据，表明许多前膝痛综合征患者的疼痛可能起源于脂肪垫和内侧支持带。
