title: Nociceptive sensory innervation of the posterior cruciate ligament in osteoarthritic knees.
abstract: BACKGROUND
  Although the posterior cruciate ligament (PCL) is considered to contain not only proprioceptive but also nociceptive sensory fibers, there is a lack of information about nociceptive sensory innervation of the PCL. We hypothesized that the PCL has constant nociceptive sensory innervation, suggesting the possible source of osteoarthritic (OA) knee pain.
  
  
  METHODS
  Innervation of the PCL was examined by immunohistochemistry with particular reference to nociceptive nerve fibers in OA knees. Sensory nerve fibers were semi-quantitatively counted in the PCL of OA knees, comparing with non-OA knees. Protein gene product 9.5 (PGP9.5) as a general neuronal marker and calcitonin gene related peptide (CGRP) as a marker for nociceptive neuron were used.
  
  
  RESULTS
  The PCLs had constant CGRP-immunoreactive (IR) nerve fibers in both OA and non-OA knees. The difference of the CGRP-IR nerve density between groups did not reach a statistical significance (p = 0.062). For PGP9.5-IR nerve fibers, however, the PCLs in OA knees were statistically less innervated than non-OA knees (p = 0.0009).
  
  
  CONCLUSIONS
  Our results showed that, in spite of a significant decrease in total innervation in OA knees, the PCLs have constant nociceptive sensory innervation. Although the relationship between the decrease in total innervations in the PCL and OA pathophysiology is still unclear, the PCL is the possible source of OA knee pain. Our results should be taken into account when examining the pain source of the OA knees and handling the PCL during total knee arthroplasty.
authors.affiliation: Department of Orthopaedic surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi 783-8505, Japan. ikeuchim@kochi-u.ac.jp
authors.forename: M
authors.initials: M
authors.lastname: Ikeuchi
authors.forename: Q
authors.initials: Q
authors.lastname: Wang
authors.forename: M
authors.initials: M
authors.lastname: Izumi
authors.forename: T
authors.initials: T
authors.lastname: Tani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D015740:Calcitonin Gene-Related Peptide / Q000032:analysis; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D059225:Nociception / Q000502:physiology*; D020370:Osteoarthritis, Knee / Q000503:physiopathology*; D010147:Pain Measurement; D016119:Posterior Cruciate Ligament / Q000294:innervation*; D011506:Proteins / Q000032:analysis; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D011506:Proteins; D015740:Calcitonin Gene-Related Peptide