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Quantitative Analysis of Nerve Changes in the Lateral Retinaculum in Patients with Isolated Symptomatic Patellofemoral Malalignment

A Preliminary Study

Vicente Sanchis-Alfonso, MD, PhD^,, Esther Roselló-Sastre, MD, PhD, Carlos Monteagudo-Castro, MD, PhD^|| and José Esquerdo, MD^a

Department of Orthopedic Surgery, Hospital Arnau de Vilanova, University of Valencia, Valencia, Spain, ^a Department of Pathology, Hospital Arnau de Vilanova, University of Valencia, Valencia, Spain, Department of Pathology, Hospital Universitario Dr. Peset, University of Valencia, Valencia, Spain, ^|| Department of Pathology, Faculty of Medicine, University of Valencia, Valencia, Spain

Presented at the 16th annual meeting of the Spanish Knee Society (SEROD), Gijón, Spain, June 1997. This paper won the Ortoimplant Award at the 17th annual meeting of SEROD, Marabella, Spain, June 1998.

Address correspondence and reprint requests to Vicente Sanchis-Alfonso, MD, PhD, Avenida Cardenal Benlloch 36, pta 23-B, 46021 Valencia, Spain

Neural damage in 16 lateral retinacula excised at the time of Insall proximal realignments or isolated lateral retinacular releases performed in patients with symptomatic patellofemoral malalignment was evaluated by means of conventional histology and immunohistochemical and morphometric analyses. A relationship between clinical and histologic findings was found. An increase in the proportion of innervated tissue was correlated with anterior knee pain syndrome. We found a significant relationship between total neural area and pain. The group with moderate pain had the highest number of nerves and the highest neural area. In reference to total neural area and pain, there was a significant difference only between the patients with moderate pain and those with light pain, but not between patients with severe pain and those with moderate pain. The group with severe pain also showed a high neural area, although with a lower number of nerves. The severe-pain group had the largest nerves (24% of nerve fibers surpassing 25 µm diameter) in a zonal disposition, in which there were groups of nerve fibers in some fields and no nerve fibers in others. The group with moderate pain had an increase in medium and small nerve fibers (mean diameter, 18 µm), predominantly of tiny perivascular fibers. Moreover, we believe that instability in patients with patellofemoral malalignment can be explained in part because of loss of proprioception due to neural damage.

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