Johnson D L, Urban W P, Caborn D N, Vanarthos W J, Carlson C S
Section of Sports Medicine, University of Kentucky School of Medicine, Lexington 40536-0284, USA.
Am J Sports Med. 1998 May-Jun;26(3):409-14. doi: 10.1177/03635465980260031101.
Occult osteochondral lesions (bone bruises) have been documented on magnetic resonance images in more than 80% of patients sustaining acute anterior cruciate ligament ruptures. Despite the high prevalence of these lesions, little is known about the histologic changes in the adjacent articular cartilage. Ten patients with acute anterior cruciate ligament ruptures who had a preoperatively documented (by magnetic resonance imaging) geographic bone bruise at the sulcus terminalis on the lateral femoral condyle underwent a 3-mm diameter trephine biopsy of the articular cartilage and subchondral bone overlying the bone bruise at the time of anterior cruciate ligament reconstruction. Biopsy samples of the articular cartilage and subchondral bone were stained with hematoxylin and eosin and toluidine blue. All patients had significant arthroscopic and histologic articular cartilage irregularity in the area overlying the bone bruise. Arthroscopic findings of the articular cartilage included softening (dimpling), fissuring, or overt chondral fracture. Histologic examination revealed degeneration of the chondrocytes and loss of toluidine blue staining in the articular cartilage (loss of proteoglycan). There was necrosis of osteocytes in the subchondral bone, and empty lacuna were visible. This study defines the exact histologic changes of the articular cartilage overlying a geographic bone bruise secondary to an acute anterior cruciate ligament tear. Our findings suggest that a geographic bone bruise found on magnetic resonance imaging indicates substantial damage to normal articular cartilage homeostasis.
在超过80%的急性前交叉韧带断裂患者的磁共振成像中已记录到隐匿性骨软骨损伤（骨挫伤）。尽管这些损伤的发生率很高，但关于相邻关节软骨的组织学变化却知之甚少。10例急性前交叉韧带断裂患者，术前经磁共振成像证实股骨外侧髁终沟处存在地图样骨挫伤，在进行前交叉韧带重建时，对骨挫伤上方的关节软骨和软骨下骨进行了直径3毫米的环钻活检。关节软骨和软骨下骨的活检样本用苏木精-伊红和甲苯胺蓝染色。所有患者在骨挫伤上方区域均有明显的关节镜和组织学关节软骨不规则改变。关节软骨的关节镜检查结果包括软化（凹陷）、裂隙或明显的软骨骨折。组织学检查显示关节软骨中的软骨细胞退变，甲苯胺蓝染色缺失（蛋白聚糖丢失）。软骨下骨中的骨细胞坏死，可见空陷窝。本研究明确了急性前交叉韧带撕裂继发地图样骨挫伤上方关节软骨的确切组织学变化。我们的研究结果表明，磁共振成像上发现的地图样骨挫伤表明正常关节软骨内环境稳定受到了实质性损害。
