Georgoulis A D, Pappa L, Moebius U, Malamou-Mitsi V, Pappa S, Papageorgiou C O, Agnantis N J, Soucacos P N
Department of Orthopaedic Surgery, Medical School, University of Ioannina, Ioannina 45110, Greece.
Knee Surg Sports Traumatol Arthrosc. 2001 Nov;9(6):364-8. doi: 10.1007/s001670100240. Epub 2001 Sep 7.
This study investigated the presence of neural mechanoreceptors in the remnants of the ruptured ACL as a possible source of reinnervation of the ACL autologous graft. The remainder of the torn ACL was selected for further histological investigation from 17 patients during ACL reconstruction 3 months to 3.5 years after injury. Perioperatively two types of ACL remnant were identified. Fifteen patients had portions of ACL adapted at the PCL. In all of these patients we found mechanoreceptors (I and II). In five patients we found mushroomlike remnants which included either none or small numbers of mechanoreceptors. Free neural ends were found in both patient groups. There was a significant difference between the groups in regard to the mean number of mechanoreceptors I and II per slice. In conclusion, in patients with an ACL remnant adapted to the PCL, mechanoreceptors exist even 3 years after injury. If we accept that restoration of proprioception is the result of reinnervation of the ACL, leaving the ACL remnants as a source, if this is surgically possible without risk of Cyclop's lesion, may be of potential benefit to the patient.
本研究调查了破裂前交叉韧带(ACL)残端中神经机械感受器的存在情况,其可能是ACL自体移植物再神经支配的一个来源。在17例患者ACL损伤后3个月至3.5年进行重建手术时,选取撕裂的ACL剩余部分进行进一步组织学研究。术中识别出两种类型的ACL残端。15例患者的部分ACL附着于后交叉韧带(PCL)。在所有这些患者中,我们发现了机械感受器(I型和II型)。在5例患者中,我们发现了蘑菇状残端,其中没有或仅有少量机械感受器。两组患者均发现了游离神经末梢。两组之间每切片I型和II型机械感受器的平均数量存在显著差异。总之,在ACL残端附着于PCL的患者中,即使在损伤3年后仍存在机械感受器。如果我们认为本体感觉的恢复是ACL再神经支配的结果,那么在手术可行且无Cyclop病变风险的情况下,保留ACL残端作为再神经支配的来源可能对患者具有潜在益处。