Macroscopic and histological evaluation of the posterior cruciate ligament in arthritic knees

Gopi Mohan, Vijay Mohan, Shyam Gopal
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Abstract

The function of Posterior Cruciate Ligament (PCL) in Total Knee Arthroplasty is currently under debate. Supporters of PCL retention suggest better soft tissue balance as well as proprioception, whereas the adversaries have reported an unstable late flexion. Whether the PCL is retained or removed, the results of knee replacement remains the same. The aim of the present study was to look for the morphologic and histological changes in PCL, that aids in assessing its competence, and to compare these with macroscopic changes. A prospective study was performed on 50 osteoarthritic knees. Both the cruciate ligaments were examined macroscopically during Total Knee Replacement surgery, and classified as normal, fatty, mucinous, or cystic. The PCL was also studied and staged histopathologically, and was compared with its macroscopic appearance. On macroscopic examination, fatty type degeneration was the most common type of degeneration in both PCL and ACL, seen in 68% and 56% cases respectively. Histopathologically, majority of the PCLs (52.4%) were in stage 1 of degeneration. 5 PCLs that appeared macroscopically normal showed degeneration microscopically and 8 PCLs that were histologically normal had fatty as well as mucinous degeneration on macroscopic examination.PCL exhibits degenerative and chronic traumatic modifications of different degrees on microscopic examination. These changes cannot be predicted from macroscopic inspection of the knee at the time of surgery. The frequency of these changes suggests that PCLs in an osteoarthritic knee are of varying quality, and this should be considered by the surgeon while selecting the type of knee replacement.
膝关节关节炎后交叉韧带的宏观和组织学评价
后交叉韧带(PCL)在全膝关节置换术中的作用目前还存在争议。PCL保留的支持者认为更好的软组织平衡和本体感觉,而反对者则报告了不稳定的晚期屈曲。无论PCL是保留还是移除,膝关节置换术的结果都是一样的。本研究的目的是寻找PCL的形态学和组织学变化,以帮助评估其能力,并将这些变化与宏观变化进行比较。对50例膝关节骨关节炎患者进行了前瞻性研究。在全膝关节置换术中检查了两个十字韧带,并将其分类为正常、脂肪、粘液或囊性。对PCL进行组织学研究和分期,并与肉眼形态进行比较。在宏观检查中,脂肪型变性是PCL和ACL中最常见的变性类型,分别占68%和56%。组织病理学上,大多数pcl(52.4%)处于1期变性。5例宏观上正常的pcl在显微镜下表现为变性,8例组织学上正常的pcl在显微镜下表现为脂肪变性和粘液变性。在显微镜检查中,PCL表现出不同程度的退行性和慢性创伤性改变。这些变化不能通过手术时膝关节的宏观检查来预测。这些变化的频率表明骨关节炎膝关节的pcl质量不同,外科医生在选择膝关节置换术类型时应考虑到这一点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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