Structure and vascularization of the cruciate ligaments of the human knee joint
Structure and vascularization of the cruciate ligaments of the human knee joint
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DOI：
10.1007/s004290050283
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发表时间：
1999-09-01
期刊：
影响因子：
--
通讯作者：
Tillmann, B
中科院分区：
文献类型：
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作者：
Petersen, W;Tillmann, B
通过光学显微镜、透射电子显微镜、注射技术和免疫组织化学研究了人类前交叉韧带和后交叉韧带的结构和血管化。前十字韧带和后十字韧带的主要部分由 I 型胶原束组成。 III 型胶原蛋白阳性原纤维将纤维束分开。主要的细胞类型是细长的成纤维细胞，单独位于平行的胶原纤维之间。十字韧带的组织学结构并不均匀。在两条韧带中都有一个区域，该区域的组织类似于纤维软骨。在前十字韧带中，纤维软骨区位于韧带前部胫骨韧带插入点近端 5-10 毫米处。在后十字韧带中，纤维软骨位于中间三分之一的中央部分。在这些区域内，细胞排列成列，细胞形状为圆形至卵形。透射电子显微镜揭示了软骨细胞的典型特征。软骨细胞被毡状细胞周基质、高含量的细胞器和细胞表面的短突起包围。细胞周胶原蛋白呈 II 型胶原蛋白阳性。十字韧带的主要血液供应来自中膝状动脉。两个十字韧带的远端部分由外侧和内侧下膝状动脉的分支提供血管。两条韧带均被滑膜皱襞包围，其中中动脉和下动脉的终末分支形成韧带周围网络。血管从滑膜鞘沿水平方向穿过韧带，并与纵向定向的韧带内血管网络吻合。韧带内的血管密度不均匀。在前十字韧带中，无血管区位于前部的纤维软骨内，韧带面向髁间窝的前缘。后十字韧带中间三分之一的纤维软骨区也是无血管的。根据 Pauwel 的“因果组织发生”理论（1960），致密结缔组织内纤维软骨发育的刺激因素是剪切应力和压缩应力。在前十字韧带中，当膝盖完全伸展时，当韧带撞击髁间窝的前缘时，可能会发生这种生物力学情况。后十字韧带中间三分之一中心的压应力和剪应力可能是由纤维束的扭曲引起的。
The structure and vascularization of the human anterior and posterior cruciate ligament were investigated by light microscopy, transmission electron microscopy, injection techniques and by immunohistochemistry. The major part of the anterior and posterior cruciate ligament is composed of bundles of type I collagen. Type III collagen-positive fibrils separate the bundles. The major cell type is the elongated fibroblast, lying solitarily between the parallel collagen fibrils. The histologic structure of the cruciate ligaments is not homogeneous. In both ligaments there is a zone where the tissue resembles fibrocartilage. In the anterior cruciate ligament the fibrocartilaginous zone is located 5-10 mm proximal of the tibial ligament insertion in the anterior portion of the ligament. In the posterior cruciate ligament the fibrocartilage is located in the central part of the middle third. Within those zones the cells are arranged in columns and the cell shape is round to ovoid. Transmission electron microscopy reveals typical features of chondrocytes. The chondrocytes are surrounded by a felt-like pericellular matrix, a high content of cellular organelles and short processes on the cell surface. The pericellular collagen is positive for type II collagen. The major blood supply of the cruciate ligaments arises from the middle geniculate artery. The distal part of both cruciate ligaments is vascularized by branches of the lateral and medial inferior geniculate artery. Both ligaments are surrounded by a synovial fold where the terminal branches of the middle and inferior arteries form a periligamentous network. From the synovial sheath blood vessels penetrate the ligament in a horizontal direction and anastomose with a longitudinally orientated intraligamentous vascular network. The density of blood vessels within the ligaments is not homogeneous. In the anterior cruciate ligament an avascular zone is located within the fibrocartilage of the anterior part where the ligament faces the anterior rim of the intercondylar fossa. The fibrocartilaginous zone of the middle third of the posterior cruciate ligament is also avascular. According to Pauwel's theory of the "causal histogenesis" (1960) the stimulus for the development of fibrocartilage within dense connective tissue is shearing and compressive stress. In the anterior cruciate ligament this biomechanical situation may occur when the ligament impinges on the anterior rim of the intercondylar fossa when the knee is fully extended. Compressive and shearing stress in the center of the middle third of the posterior cruciate ligament may result from twisting of the fiber bundles.