Ultrastructure and Innervation of Thumb Carpometacarpal Ligaments in Surgical Patients With Osteoarthritis

• Published in: Clinical orthopaedics and related research Vol. 472; no. 4; pp. 1146 - 1154
• Main Authors: Mobargha, Nathalie, Ludwig, Cassie, Ladd, Amy L., Hagert, Elisabet
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.04.2014; Lippincott Williams & Wilkins Ovid Technologies
• Subjects: Aged; Aged, 80 and over; Biomarkers - analysis; Biomechanical Phenomena; Carpometacarpal Joints - chemistry; Carpometacarpal Joints - innervation; Carpometacarpal Joints - surgery; Carpometacarpal Joints - ultrastructure; Collagen - analysis; Conservative Orthopedics; Female; Fluorescent Antibody Technique; Hand; Humans; Ligaments - chemistry; Ligaments - innervation; Ligaments - surgery; Ligaments - ultrastructure; Male; Mechanoreceptors - chemistry; Mechanoreceptors - ultrastructure; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Middle Aged; Nerve Tissue Proteins - analysis; Orthopedics; Osteoarthritis - pathology; Osteoarthritis - physiopathology; Osteoarthritis - surgery; Osteotomy; Receptors, Nerve Growth Factor - analysis; Sports Medicine; Surgery; Surgical Orthopedics; Symposium: Thumb Carpometacarpal Arthritis; Thumb - innervation; Ubiquitin Thiolesterase - analysis; Neuromuscular Control; Ulnar Collateral Ligament; Sensory Nerve Ending; Nerve Fascicle; Triple Staining
• ISSN: 0009-921X; 1528-1132; 1528-1132
• DOI: 10.1007/s11999-013-3083-7

Background The complex configuration of the thumb carpometacarpal (CMC-1) joint relies on musculotendinous and ligamentous support for precise circumduction. Ligament innervation contributes to joint stability and proprioception. Evidence suggests abnormal ligament innervation is associated with osteoarthritis (OA) in large joints; however, little is known about CMC-1 ligament innervation characteristics in patients with OA. We studied the dorsal radial ligament (DRL) and the anterior oblique ligament (AOL), ligaments with a reported divergent presence of mechanoreceptors in nonosteoarthritic joints. Questions/purposes This study’s purposes were (1) to examine the ultrastructural architecture of CMC-1 ligaments in surgical patients with OA; (2) to describe innervation, specifically looking at mechanoreceptors, of these ligaments using immunohistochemical techniques and compare the AOL and DRL in terms of innervation; and (3) to determine whether there is a correlation between age and mechanoreceptor density. Methods The AOL and DRL were harvested from 11 patients with OA during trapeziectomy (10 women, one man; mean age, 67 years). The 22 ligaments were sectioned in paraffin and analyzed using immunoflourescent triple staining microscopy. Results In contrast to the organized collagen bundles of the DRL, the AOL appeared to be composed of disorganized connective tissue with few collagen fibers and little innervation. Mechanoreceptors were identified in CMC-1 ligaments of all patients with OA. The DRL was significantly more innervated than the AOL. There was no significant correlation between innervation of the DRL and AOL and patient age. Conclusions The dense collagen structure and rich innervation of the DRL in patients with OA suggest that the DRL has an important proprioceptive and stabilizing role. Clinical Relevance Ligament innervation may correlate with proprioceptive and neuromuscular changes in OA pathophysiology and consequently support further investigation of innervation in disease prevention and treatment strategies.