| Objectives: Knee joint osteoarthritis(knee joint osteoarthritis, KOA) is a chronic, degenerative joint disease, which is usually occurred in the elderly. KOA often causes a series of changes, including bone hyperplasia, cartilage exfoliation, meniscus or ligament injury, as well as synovial inflammation, which might seriously affect the quality of life in the elderly. Therefore, the prevention and treatment of KOA become a key research hotspot.There are both the problems of joint stiffness, pain, adverse events, and deficiency of the knee joint proprioception in KOA patients. Proprioception of the knee joint mainly comes from the mechanoreceptor on muscles, tendon, capsule and ligament around the knee joint. The study of anterior cruciate ligament(anterior cruciate ligament, ACL) mechanoreceptor is the best and most widely performed. It is reported that age is an important factor of knee proprioception missing. However, whether there is a certain relationship between the age of KOA patients and proprioception missing is unknown, and what changes will happen to the morphology and the number of mechanoreceptor in the ACL of KOA patients in also not clear. The related researches on these problems are relatively rare. Meanwhile, severity of the disease also has a correlation with knee proprioception missing. But, what kind of quantitative relationship exists between them is unknown, and what changes happen to the morphology and the number of mechanoreceptor in the ACL of KOA patients are not clear.The purpose of this study was to:(1) observe the changes of the morphology and the number of mechanoreceptor in the ACL of KOA patients at different ages, and find the correlation between age and knee proprioception.(2) Observe the changes of the morphology and the number of mechanoreceptor in the ACL of KOA patients with different severity of the disease, find the quantitative relationship between KOA severity and knee proprioception.Methods:There were more female than male in KOA patients. Therefore, to eliminate the influence of gender on the experimental research, all the cases in this experiment were female patients with KOA. All patients with clinical symptoms were consistent with American college of rheumatology(ACR) of 2001 KOA diagnosis standard. Meanwhile, according to the Kellgren-Lawrenc e knee joint osteoarthritis imaging protocol, selected standard level III of 36 women patients with KOA, standard level IV of 12 women patients were enrolled in this stud. All patients underwent total knee arthroplasty(TKA) voluntarily. According to age, 36 cases of level III patients were randomly divided into 3 groups, group A(age 50-60,III), group B(age 60-70, III), group C(>70, III), each group of 12 cases. 12 cases with level IV for the group D(>70, IV). Among them, the samples form randomly selected 6 cases of each group were used for HE staining, and the samples from the remaining 6 cases were used for immunohistochemical study. After all of the patients undergoing TKA, the tissues which were intercepted from the ACL of tibial point part were placed in 4% paraformaldehyde. Following 48-72 hours, the tissues were divided into size of 0.5×0.5×0.5 cm. After Washing shock, dehydration, dipping wax, paraffin embedding, slice thickness(5 μm), HE staining and immunohistochemical staining were used to detect the morphology and the number of mechanoreceptors like Pacinian corpuscles(PC), Ruffini endings(RE), Golgi tedon organ like ending(GTOE), Free nerve endings(FNE). Each group of 6 patients with HE staining, 6 slices per patient, each slice was analyzed by JEDA801 D morphological image analysis software. Five horizons with more mechanoreceptors were randomly selected. After counting the total number of various types of mechanoreceptors from each patient, the average of all kinds of mechanoreceptors of 6 patients was obtained. The effect of age and KOA severity on all kind of mechanoreceptors and the quantitative relationship were compared among them; each group of 6 patients with immunohistochemical staining underwent the same procedures. Then observe the morphological changes of mechanoreceptor in ACL in four groups. The number of all kind of mechanoreceptors in ACL was counted to find if there was any significant statistical difference among group A, B, C which grouped by the age and group C, D which grouped by the KOA severity.Results: HE staining results showed that the mechanoreceptor PC was found. With increase of age, capsules in type of onion skinning which composed of 15 to 30 layer flat nerve cells were gradually shrinked. The oval or elliptical receptors are gradually shrinked and deformed. Finally, they become irregular shape. The average value of group A is 9.33±1.21, group B is 7.67±1.03, group C is 2.67±1.03, group D is 1.00±0.63, this set of data revealed significant difference of average value about A, B, C pairwise comparison between three groups which group by patient age(P<0.05) and there is significant difference of average value between group C and D which were grouped by KOA severity(P<0.05). Immunohistochemical results showed the situation of mechanoreceptor RE and FNE.(1) For RE, with the increase of age in patients, round or ovoid receptors are gradually shrinking, and the outer thin connective tissue capsule are irregular changeed and deformaed. The average value of group A is 14.33±4.08, group B is10.33±1.86, group C is 6.00±2.45, group D is 2.50±1.23, this set of data revealed significant difference of average value about A, B, C pairwise comparison between three groups which group by patient age(P<0.05) and there is significant difference of average value between group C and D which group by KOA severity(P<0.05).(2) For FNE results, with the increase of patient age, receptors are disorganized and loosened. And the direction of FNE changed from parallel with ligament to irregular set. Meanwhile, the receptors are atrophy and deformed. The value of group A is 22.33±4.08, group B is16.50±3.21, group C is 10.00±3.74, group D is 5.50±1.05, this set of data revealed significant difference of average value about A, B, C pairwise comparison between three groups which group by patient age(P<0.05) and there is significant difference of average value between group C and D which group by KOA severity(P<0.05). HE staining and immunohistochemical staining all failed to detect mechanoreceptor GTOE.Conclusions:(1) With the increase of age in KOA patients, the number of ACL mechanoreceptor decreased and the type of mechanoreceptor was deformed, while knee joint proprioception declined.(2) With the increase of severity of KOA in patients, the number of ACL mechanoreceptor decreased and the type of mechanoreceptor was deformed, while knee joint proprioception declined. |
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