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2002 - University of Washington Bone and Joint Sources

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Using a Freeze Fixation Technique <strong>and</strong> Histological Crimp<br />

Analysis for Mapping the Strain in Functionally Loaded<br />

Ligaments<br />

RICHARD BOORMAN, M.D., M.SC., TONY NORMAN, B.S.E., FREDERICK A. MATSEN III, M.D.,<br />

AND JOHN CLARK, M.D., PH.D.<br />

In a non-loaded state, type I collagen<br />

fibrils in tendons <strong>and</strong> ligaments<br />

assume a sinusoidal wave shape that<br />

disappears with modest tensile loads<br />

(Gathercole <strong>and</strong> Keller, 1991). This<br />

“crimp” is visible by polarized light<br />

microscopy because collagen fibrils are<br />

aligned in uniform register. A better<br />

underst<strong>and</strong>ing <strong>of</strong> how ligaments<br />

distribute load may yield critical<br />

information on how they fail with<br />

injury <strong>and</strong> disease. Yet the response <strong>of</strong><br />

crimp to load has, by necessity, been<br />

studied primarily in subunits <strong>of</strong><br />

tendons <strong>and</strong> ligaments small enough to<br />

transilluminate <strong>and</strong> not under<br />

functional loading conditions. Freezesubstitution<br />

fixation <strong>of</strong> tissues plungefrozen<br />

under load permits conventional<br />

polarized light <strong>and</strong> electron microscopy<br />

examination <strong>of</strong> collagen fibers<br />

preserved in a loaded state. This study<br />

examines whether the distribution <strong>of</strong><br />

strain can be mapped in loaded<br />

ligaments frozen in situ <strong>and</strong> fixed by<br />

freeze-substitution. In a second line <strong>of</strong><br />

investigation crimping behavior <strong>of</strong><br />

partially sectioned, loaded ligaments<br />

preserved by freeze-fixation was used<br />

to determine whether ligaments are<br />

Figure 1: Unloaded ligament- Crimped - 12X.<br />

composed <strong>of</strong> independent bundles <strong>of</strong><br />

interconnected fibrils. We hypothesized<br />

that (A) the crimping pattern <strong>of</strong> patellar<br />

ligaments under polarized light would<br />

progressively extinguish with increasing<br />

loads, <strong>and</strong> (B) that fibrils within a<br />

loaded “functional b<strong>and</strong>” would not<br />

recoil into a uniformly un-crimped<br />

state unless the entire b<strong>and</strong> is<br />

transected.<br />

METHODS AND MATERIALS<br />

Hind-limbs <strong>of</strong> 11 mature New<br />

Zeal<strong>and</strong> white rabbits sacrificed<br />

according to the ethical guidelines <strong>of</strong><br />

the local animal care committee were<br />

harvested, <strong>and</strong> the s<strong>of</strong>t tissues dissected<br />

leaving the femur- intact stifle joint<strong>and</strong><br />

tibia <strong>and</strong> extensor mechanism<br />

completely intact. The joint was fixed<br />

on to a frame while flexed at 90 o , <strong>and</strong> a<br />

simulated isometric quadriceps pull<br />

was applied by means <strong>of</strong> a wire passed<br />

through the patella, thus functionally<br />

loading the patellar ligament.<br />

Specimens were loaded at 9N (n=3),<br />

18N (n=3), 36N (n=3), 67N (n=3),<br />

100N (n=1), <strong>and</strong> 220N (n=1). After 30<br />

seconds a loaded joint was immersed<br />

in isopentane cooled to –165 0 C with<br />

liquid nitrogen. These knees <strong>and</strong> 2 unloaded<br />

control specimens were then<br />

fixed by freeze-substitution in<br />

methanol/acetone solutions <strong>of</strong> acrolein<br />

(-80 o C for 4 days) <strong>and</strong> glutaraldehyde<br />

(-20 o C for a further 4 days). Once<br />

brought to room temperature, the<br />

patellar ligaments were prepared for<br />

histological examination by paraffin<br />

embedding, 10um sectioning in the<br />

mid-sagittal plane <strong>and</strong> staining with<br />

Masson’s trichrome. The specimens<br />

were analyzed under polarized light<br />

microscopy, <strong>and</strong> the crimp pattern was<br />

analyzed by an observer blinded to the<br />

loading history. Based upon the relative<br />

amount <strong>of</strong> un-crimped tissue a<br />

speculation was recorded by the<br />

blinded observer as to whether no load,<br />

minimal load (9N), moderate load (18<br />

<strong>and</strong> 36N), or high load (>67N) was<br />

applied.<br />

Collagen Fiber Interaction<br />

Three specimens had a “deep”<br />

transverse scalpel cut made through the<br />

anterior b<strong>and</strong> <strong>of</strong> the patellar ligament<br />

at the mid-point. Three specimens had<br />

a“superficial” cut partially through the<br />

anterior b<strong>and</strong>. All these specimens were<br />

loaded at 150N. Two uncut controls<br />

were similarly loaded at 150N.<br />

Specimens were prepared for polarized<br />

light microscopy <strong>and</strong> scanning electron<br />

microscopy.<br />

RESULTS<br />

Unloaded ligaments displayed a<br />

consistent, regular pattern <strong>of</strong> crimp<br />

along the entire length <strong>of</strong> the specimens<br />

(Figure 1). The specimens loaded at 9<br />

Newtons were virtually<br />

indistinguishable from the unloaded<br />

specimens, with the exception <strong>of</strong> one<br />

specimen which had some uncrimping<br />

near the insertions. The specimens<br />

loaded at 18N had a b<strong>and</strong> <strong>of</strong> uncrimping<br />

in the central 1/3 <strong>of</strong> the<br />

ligament.<br />

The specimens loaded at 36 N had<br />

an increased area <strong>of</strong> un-crimping but<br />

crimping was still evident in the deep<br />

<strong>and</strong> superficial fibers <strong>of</strong> the ligaments<br />

32 <strong>2002</strong> ORTHOPAEDIC RESEARCH REPORT

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