The innervation of the human acetabular labrum and hip joint: an anatomic study

BMC Musculoskeletal Disorders

James N Powell¹  John R Matyas¹  Dragana Ponjevic¹  Pamela Railton¹  Ravi Gudena¹  Kamal Bali¹  Abdullah Alzaharani¹ 

[1] Orthopedic Trauma & Lower Extremity Reconstruction, 3134 Hospital Drive N.W, Calgary, Alberta T2N 5A1, Canada

关键词: Labral tear;    Hip arthroscopy;    Femoro-acetabular impingement;    Innervation;    Labrum;   

Others  :  1128808
DOI  :  10.1186/1471-2474-15-41

 received in 2013-07-30, accepted in 2014-02-10,  发布年份 2014

【 摘 要 】

Background

The aim of the current study was to evaluate the innervation of the acetabular labrum in the various zones and to understand its potential role in nociception and proprioception in hips with labral pathology.

Methods

A total of twenty hip labrums were tagged and excised intraoperatively from patients undergoing a total hip replacement. After preparation, the specimens were cut to a thickness of 10 μm and divided into four quadrants (zones) using a clock face pattern. Neurosensory structure distribution was then evaluated using Hematoxylin and Eosin (H and E), and immunoreactivity to S-100.

Results

All specimens had abundant free nerve endings (FNEs). These were seen predominantly superficially and on the chondral side of the labrum. In addition, predominantly three different types of nerve end organs (NEOs) were identified in all twenty specimens. FNEs and NEOs were more frequently seen in the antero-superior and postero-superior zones. Four specimens had abundant vascularity and disorganised architecture of FNEs in the deeper zones of the antero-superior quadrant suggestive of a healed tear. Myofibroblasts were present in abundance in all the labral specimens and were distributed uniformly throughout all labral zones and depth.

Conclusions

The current study shows that the human acetabular labrum has abundant FNEs and NEOs. These are more abundant in the antero-superior and postero-superior zones. The labrum, by virtue of its neural innervation, can potentially mediate pain as well as proprioception of the hip joint, and be involved in neurosecretion that can influence connective tissue repair.

【 授权许可】

   
2014 Alzaharani et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

Figure 7.

Figure 8.

【 参考文献 】

• [1]Petersen W, Petersen F, Tillmann B: Structure and vascularization of the acetabular labrum with regard to the pathogenesis and healing of labral lesions. Arch Orthop Trauma Surg 2003, 123(6):283-288.
• [2]Altenberg AR: Acetabular labrum tears: a cause of hip pain and degenerative arthritis. South Med J 1977, 70(2):174-175.
• [3]Ueo T, Suzuki S, Iwasaki R, Yosikawa J: Rupture of the labra acetabularis as a cause of hip pain detected arthroscopically, and partial limbectomy for successful pain relief. Arthroscopy 1990, 6(1):48-51.
• [4]Beck M, Kalhor M, Leunig M, Ganz R: Hip morphology influences the pattern of damage to the acetabular cartilage: femoroacetabular impingement as a cause of early osteoarthritis of the hip. J Bone Joint Surg (Br) 2005, 87(7):1012-1018.
• [5]Tibor LM, Leunig M: The pathoanatomy and arthroscopic management of femoroacetabular impingement. Bone Joint Res 2012, 1(10):245-257.
• [6]Kelly BT, Williams RJ 3rd, Philippon MJ: Hip arthroscopy: current indications, treatment options, and management issues. Am J Sports Med 2003, 31(6):1020-1037.
• [7]Byrd JW, Jones KS: Hip arthroscopy in athletes. Clin Sports Med 2001, 20(4):749-761.
• [8]Safran MR: The acetabular labrum: anatomic and functional characteristics and rationale for surgical intervention. J Am Acad Orthop Surg 2010, 18(6):338-345.
• [9]Zaltz I: The biomechanical case for labral débridement. Clin Orthop Relat Res 2012, 470(12):3398-3405.
• [10]Kim YT, Azuma H: The nerve endings of the acetabular labrum. Clin Orthop Relat Res 1995, 320:176-181.
• [11]Shirai C, Ohtori S, Kishida S, Harada Y, Moriya H: The pattern of distribution of PGP 9.5 and TNF-alpha immunoreactive sensory nerve fibers in the labrum and synovium of the human hip joint. Neurosci Lett 2009, 450(1):18-22.
• [12]Gerhardt M, Johnson K, Atkinson R, Snow B, Shaw C, Brown A, Vangsness CT Jr: Characterisation and classification of the neural anatomy in the human hip joint. Hip Int 2012, 22(1):75-81.
• [13]Haversath M, Hanke J, Landgraeber S, Herten M, Zilkens C, Krauspe R, Jäger M: The distribution of nociceptive innervation in the painful hip: a histological investigation. Bone Joint J 2013, 95(6):770-776.
• [14]Hosokawa O: Histological study on the type and distribution of the sensory nerve endings in human hip joint capsule and ligament. [Article in Japanese]. Nihon Seikeigeka Gakkai Zasshi 1964, 38:887-901.
• [15]Putz R, Schrank C: Anatomy of the labro-capsular complex. [Article in German]. Orthopade 1998, 27(10):675-680.
• [16]James SL, Ali K, Malara F, Young D, O’Donnell J, Connell DA: MRI findings of femoroacetabular impingement. AJR Am J Roentgenol 2006, 187(6):1412-1419.
• [17]Day B, Mackenzie WG, Shim SS, Leung G: The vascular and nerve supply of the human meniscus. Arthroscopy 1985, 1(1):58-62.
• [18]Wyss TF, Clark JM, Weishaupt D, Nötzli HP: Correlation between internal rotation and bony anatomy in the hip. Clin Orthop Relat Res 2007, 460:152-158.
• [19]Kelly BT, Shapiro GS, Digiovanni CW, Buly RL, Potter HG, Hannafin JA: Vascularity of the hip labrum: a cadaveric investigation. Arthroscopy 2005, 21(1):3-11.
• [20]Seldes RM, Tan V, Hunt J, Katz M, Winiarsky R, Fitzgerald RH Jr: Anatomy, histologic features, and vascularity of the adult acetabular labrum. Clin Orthop Relat Res 2001, 382:232-240.
• [21]Tomasek JJ, Gabbiani G, Hinz B, Chaponnier C, Brown RA: Myofibroblasts and mechano-regulation of connective tissue remodelling. Nat Rev Mol Cell Biol 2002, 3(5):349-363.
• [22]Gabbiani G: The myofibroblast in wound healing and fibrocontractive diseases. J Pathol 2003, 200(4):500-503.
• [23]Jester JV, Petroll WM, Barry PA, Cavanagh HD: Expression of alpha-smooth muscle (alpha-SM) actin during corneal stromal wound healing. Invest Ophthalmol Vis Sci 1995, 36(5):809-819.
• [24]Salo P, Bray R, Seerattan R, Reno C, McDougall J, Hart DA: Neuropeptides regulate expression of matrix molecule, growth factor and inflammatory mediator mRNA in explants of normal and healing medial collateral ligament. Regul Pept 2007, 142(1–2):1-6.