Cushner Fred D, La Rosa David F, Vigorita Vincent J, Scuderi Giles R, Scott W Norman, Insall John N
Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, Beth Israel Medical Center-Singer Division, New York, New York, USA.
J Arthroplasty. 2003 Sep;18(6):687-92. doi: 10.1016/s0883-5403(03)00256-0.
Newer prosthetic total knee arthroplasty (TKA) designs as well as unicondylar TKAs spare the anterior cruciate ligament (ACL). Although success of these procedures requires near normal ACL function, little has been written about the histologic features or the arthritic ACL. This study was designed to histologically evaluate the ACL for microscopic evidence of degeneration. Nineteen ACLs were harvested from 16 different patients who underwent TKA as a result of severe osteoarthritis. Control ligaments were obtained from bone bank donors (N = 14), patients with above-knee amputations (N = 5), and cadaveric formalin-preserved knees (N = 6). Orientation was maintained for each ACL. Degenerative parameters included loose, fibrous connective tissue and myxoid and cystic occurrences, and the presence of chondroid metaplasia or calcium phosphate crystals were evaluated and scored. Forty-seven percent of the osteoarthritic group had moderate/marked degeneration, whereas no control specimen showed such changes. Seventy-two percent of the controls were considered normal, compared with only 26% of the osteoarthritic group. Both of these findings were statistically significant (P<.001). Statistical analysis revealed no gender bias either within or between groups. In the control group, no statistical difference was found between patients older than age 65 and those younger than 65. In the osteoarthritic group, however, 70% of patients younger than 65 demonstrated moderate/marked changes compared with only 22% of those older than 65 (P<.05). There also was no difference demonstrated between the 4 focal sections of the ligaments that were examined.
新型人工全膝关节置换术（TKA）设计以及单髁膝关节置换术均保留了前交叉韧带（ACL）。尽管这些手术的成功需要近乎正常的ACL功能，但关于ACL的组织学特征或患有关节炎的ACL的文献却很少。本研究旨在通过组织学方法评估ACL的微观退变证据。从16例因重度骨关节炎接受TKA手术的不同患者身上获取了19条ACL。对照韧带取自骨库供体（n = 14）、膝上截肢患者（n = 5）以及用福尔马林保存的尸体膝关节（n = 6）。每条ACL均保持其原有方向。退变参数包括疏松的纤维结缔组织、黏液样和囊性病变，以及软骨样化生或磷酸钙晶体的存在情况，并进行评估和评分。骨关节炎组中47%的患者存在中度/重度退变，而对照标本未显示出此类变化。72%的对照标本被认为正常，而骨关节炎组仅为26%。这两个结果均具有统计学意义（P <.001）。统计分析显示组内和组间均无性别差异。在对照组中，65岁以上患者与65岁以下患者之间未发现统计学差异。然而，在骨关节炎组中，65岁以下患者中有70%表现出中度/重度变化，而65岁以上患者中仅为22%（P <.05）。所检查的韧带的4个局部切片之间也未显示出差异。
