Immunohistochemical
analysis of sensory nerve
endings in ankle ligaments
A cadaver study
Susanne Rein1, Elisabet Hagert2, Uwe Hanisch3,
Sophie Lwowski1, Armin Fieguth4, Hans Zwipp1
1Trauma
Surgery, University Hospital „Carl Gustav Carus“, Dresden, Germany
Institutet, Hand&Foot Surgery Center, Stockholm, Sweden
3 Pathology, Hospital „Carl Thiem“, Cottbus, Germany
4 Legal medicine, Medical Faculty, Hannover, Germany
2 Karolinska
Conflict of interest statement
My disclosure is in the Final AOFAS Program Book.
I have a potential conflict with this presentation due to:
This study has been supported financially
by the Technical University of Dresden
(MedDrive 33), Germany
Material
Dissection of 140 ankle ligaments from
10 human cadaver feet
Anatomical complexes
syndesmosis
• ATiFL
•
•
•
•
lateral
medial
sinus tarsi
• ATFL
• CFL
• PTFL
• TNL
• TCL
• STTL
• ATTL
• PTTL
• IER (L, I, M)
• TCOL
• CTL
S-100 protein
neurotrophin receptor p75
protein gene product 9,5
smooth muscle actin
Histology
HE
p75
S100
Ruffini endings
oil-shaped (type I)
•
• partial encapsulated
• dendritic nerve endings with
PGP 9.5
bulbous terminals
• size: 50-100µm
Pacini corpuscles
(type II)
• rounded, ovular
• multilayered lamellar capsule
• size: 20-150µm
HE
S100
p75
PGP 9.5
HE
p75
S100
PGP 9.5
Golgi-like endings
(type III)
•
•
•
•
large spherical
partial encapsulated
groups of dendritic endings
size: 150-180µm
Free nerve endings
(type IV)
• Varicose appearance
• often close to vessels
• groups or single fibers
HE
S100
p75
PGP 9.5
General distribution (n=140)
significant differences between all sensory corpuscles
(p<0.0001, respectively), except Ruffini vs. Unclassifiable
Anatomical complexes
* p≤0.005 ATiFL vs. Medial;
R vs. P (§); R vs. G (#); U vs. P, G (+)
Free nerve endings and blood vessels
* Lateral; § Medial, respectively p<0.008
Conclusions
free nerve endings are the dominant receptor
type, followed by Ruffini endings.
lateral and medial ankle complexes are more
innervated than the sinus tarsi ligaments.
abundance of sensory nerve endings in ankle
ligaments indicates a crucial role in
coordination and proprioception of the foot
Abbreviations
distal tibiofibular syndesmosis
ATiFL = anterior tibiofibular ligament
lateral complex
ATFL = anterior talofibular; CFL = calcaneofibular; PTFL = posterior talofibular ligament
medial complex
a) superficial layer
TNL = tibionavicular; TCL = tibiocalcaneal; STTL = superficial tibiotalar ligament
b) deep layer
ATTL = anterior tibiotalar; PTTL = posterior tibiotalar ligaments
sinus tarsi
IER (L, I, M) = inferior extensor retinaculum with its lateral, intermediate and medial roots
TCOL = talocalcaneal oblique ligament; CTL = canalis tarsi ligament
References
Pankovich AM, Shivaram MS. 1979. Anatomical basis of variability in injuries of the medial malleolus and the
deltoid ligament. I. Anatomical studies. Acta Orthop Scand 50:217-223.
Schmidt HM. 1978. Gestalt und Befestigung der Bandsysteme im Sinus und Canalis tarsi des Menschen. Acta
Anat (Basel) 102:184-194.