Age-related changes of elements and relationships among elements in human tendons and ligaments

To elucidate compositional changes of the tendons and ligaments with aging, the authors investigated age-related changes of element contents in the insertion tendons of the biceps brachii muscle, central tendons of the diaphragma, Achilles’ tendons, posterior longitudinal ligaments (PLLs) of the cervical spine, ligamenta capitum femorum, and anterior cruciate ligaments. After ordinary dissections by medical students, the three tendons and three ligaments were resected and element contents were determined by inductively coupled plasma-atomic emission spectrometry. It was found that the elements, such as Ca, P, S, Mg, Na, Zn, and Fe, did not change significantly in the three tendons and two ligaments with aging, except for the PLLs where Ca and Mg increased significantly with aging and Fe decreased significantly with aging. With regard to the relationships among elements, the common finding that there were significant correlations between Ca and P contents and between Ca and Mg contents was obtained in the three ligaments. Likewise, the common finding that there was a significant correlation between Ca and Mg contents was obtained in the three tendons. Regarding the relationship between Ca and P contents, the three tendons were different from the three ligaments.     

Age-dependent decreases of sulfur and magnesium in human round ligaments of the uterus and relationships among elements

To elucidate the compositional change of ligaments with aging, the authors investigated both age-related changes of elements and relationships among elements in the round ligaments of the uterus (round ligaments) by inductively coupled plasma-atomic emission spectrometry. The bilateral round ligaments were resected from 20 cadavers and also from the uteri removed surgically from 11 patients bearing uterine myoma or cancer. Thirty-one subjects ranged in age from 34 to 92 yr. It was found that both S and Mg decreased gradually in the round ligaments with aging, but Ca, P, Zn, Fe, and Al did not change significantly with aging. Regarding the relationships among elements, very significant direct correlations were found among the contents of Ca, P, S, and Mg in the round ligaments, whereas significant inverse correlations were found between the contents of Zn and elements, such as Ca, P, S, and Mg. It should be noted that there was an extremely significant direct correlation between Ca and P contents in the round ligaments.     

Age-related changes of elements in human thoracic ducts and azygos veins and relationships among elements

To elucidate compositional changes of the thoracic duct with aging, the authors investigated age-related changes of elements in the thoracic ducts in comparison with the azygos veins. The subjects consisted of 22 men and 1 woman, ranging in age from 65 to 95 yr. After ordinary dissection, the thoracic ducts and azygos veins were resected from the subjects and element contents were determined by inductively coupled plasma-atomic emission spectrometry. It was found that calcium appeared to increase in the thoracic duct with aging, but the other elements, such as phosphorus, sulfur, magnesium, iron, zinc, and sodium, did not change significantly with aging. In the azygos vein, both calcium and sulfur increased significantly with aging. Regarding the relationship among elements, extremely significant direct correlations were found among calcium, phosphorus, sulfur, and magnesium in the thoracic ducts, except for phosphorus and magnesium contents with a very significant direct correlation. In the azygos veins, significant direct correlations were found between calcium and sulfur contents and between sulfur and magnesium contents. However, no significant correlations were found among calcium, phosphorus, and magnesium in the azygos veins. These results revealed that with regard to the relationship among calcium, phosphorus, and magnesium, the thoracic duct was similar to the arteries, but not to the azygos vein.     

Age-related changes of elements in human ureter

To elucidate changes of the ureter with aging, the authors investigated age-related changes of element contents in human ureters. The subjects consisted of seven men and seven women, ranging in age from 61 to 97 yr. The contents of calcium, sulfur, and iron in the ureters increased progressively with aging, whereas the contents of phosphorus and magnesium did not increase with aging. Significant relationships were found both between calcium and sulfur contents and between calcium and iron contents in the ureters, but not between calcium and either phosphorus or magnesium contents. It was noteworthy that a significant relationship was also found between sulfur and iron contents in the ureters. It remains uncertain whether calcium forms a compound with sulfur or iron in aged human ureters or not.     

Age-related changes of elements in the human articular disk of the temporomandibular joint

To elucidate compositional changes of the articular disk (AD) of the temporomandibular joint (TMJ) by aging, elements of the ADs resected from 18 cadavers were determined by inductively coupled plasma atomic-emission spectrometry. It was found that calcium contents of ADs in TMJs increased progressively with aging, whereas the sulfur contents of the ADs decreased slightly with aging. Regarding the content of phosphorus, the contents increased progressively with aging. The study revealed that age-related changes of calcium contents in the ADs of TMJs were similar to those in women’s pubic symphyses, but not those in intervertebral disks and menisci.     

Age-related changes of element contents in the human meniscus

The relative contents (RCs) of elements in the human menisci from 23 subjects in the age range between 65 and 93 yr were analyzed by inductively coupled plasma atomic emission spectrometry. The RCs of sulfur, calcium, and phosphorus in menisci increased progressively until the 80s, being the highest in the 80s, and thereafter decreased. The RCs of magnesium in menisci increased progressively until the 90s. Regarding the medial and lateral menisci, higher RCs of magnesium and iron, and a lower RC of phosphorus were found in lateral menisci in comparison with those in medial menisci. There were sexual differences in the RCs of calcium and phosphorus of medial and lateral menisci. The RCs of calcium and phosphorus were about 50% higher in women’s menisci than in men’s. Histological examinations showed that structureless mucoid masses were observed in the menisci, with very high RCs of calcium and phosphorus being detected.     

Age-related changes of elements in renal arteries of Thai and Japanese and the relationships among elements

To examine whether there were differences between reces in regard to age-related changes of elements and the relationships among elements in the arteries, the authors investigated both the renal arteries of Thai and Japanese. The Thai subjects consisted of 27 men and 11 women, ranging in age from 27 to 88 yr, whereas the Japanese subjects consisted of 19 men and 26 women, ranging in age from 61 to 99 yr. After the ordinary dissections at Chiang Mai University and Nara Medical University were completed, the bilateral renal arteries were resected and the element contents were determined by inductively coupled plasma-atomic emission spectrometry. In the Thai, a slight accumulation of calcium and phosphorus occurred in the fifties, but thereafter headly increased. In contrast, in the Japanese, an accumulation of calcium and phosphorus began to occur in the seventies and increased markedly in the eighties. The result reveraled that a higher accumulation of calcium and phosphorus occurred in the renal arteries of the Japanese in old age compared with those of the Thai. Regarding the relationships among elements, extremely or very significant direct correlations were found among the contents of calcium, phosphorus, magnesium, and sodium in both the renal arteries of the Thai and Japanese, except for magnesium and sodium contents in the renal arteries of the Thai.     

Age-related changes of elements and relationships among elements in the common bile and pancreatic ducts

To elucidate compositional changes of the common bile and main pancreatic ducts with aging, the authors investigated age-related changes of element contents in the common bile and pancreatic ducts by inductively coupled plasma-atomic emission spectrometry. After ordinary dissection by medical students was finished, the common bile ducts and main pancreatic ducts (pancreatic ducts) were resected and the element contents were determined. The Mg content increased significantly only in the pancreatic duct with aging, but the other element contents did not change significantly in both the common bile and pancreatic ducts with aging. Regarding the relationship among the elements, significant direct correlations were found among the contents of Ca, P, S, and Mg in the common bile ducts, with some exceptions between P and either S or Mg contents. In the pancreatic ducts, significant direct correlations were found between S and Mg contents and between P and Na contents. The relationships in the elements between the common bile and pancreatic ducts were examined. It was found that there were significant direct correlations in the Ca, Mg, and Fe contents between the common bile and pancreatic ducts; that is, as Ca, Mg, and Fe increased in the common bile duct, they increased simultaneously in the pancreatic duct.     

Age-dependent changes of elements in human trachea

To elucidate compositional changes of human trachea by aging, element contents in tracheae were determined by inductively coupled plasma-atomic emission spectrometry. The subjects consisted of seven men and seven women, ranging in age from 61 to 97 yr. The sulfur content of the tracheae decreased gradually with aging. In regard to calcium and phosphorus, both the contents increased to about three-fold amounts in their seventies compared with those in their sixties, and decreased thereafter. The contents of calcium and phosphorus were the highest in their seventies. Therefore, it is likely that surplus calcium released from bones is deposited temporally in the trachea, and the deposits are released from the trachea at older age. Based on our results of human cartilages, there are two types in regard to calcium accumulation: The first type is that calcium accumulation occurs progressively with aging; the second one is that calcium accumulation becomes the highest in the seventies or eighties, and decreases there-after. Therefore, the trachea belongs to the second type. Furthermore, the magnesium content remained constant through the age range.     

Effect of knee musculature on anterior cruciate ligament strain in vivo

Squatting is a commonly prescribed exercise following reconstruction of the anterior cruciate ligament (ACL). The objective of this paper was to measure the in vivo strain patterns of the normal ACL and the load at the knee for the simple squat and for squatting with a “sport cord”. A sport cord is a large elastic rubber tube used for added resistance. Strain patterns were deduced using displacement data from a Hall Effect Strain Transducer (HEST), while joint loads were determined by a mathematical model with inputs from a force plate and electrogoniometers. ACL strain for the free squat in one subject had a maximum of 2% at a knee angle of 10° and was slack for knee angles >17°. In squatting with a sport cord, peak strain was 1% at 10° and was slack at knee angles >14°. Since these peak strains are low, squatting appears to be a safe exercise for conservative rehabilitation of ACL reconstruction patients. In addition, the sport cord is a recommended augmentation to the activity. We believe that the decrease in strain with the sport cord results from added joint stiffness due to greater compressive forces at the tibiofemoral joint. This greater compressive force results from the approximately 10% increase in quadriceps activity. From shear force data predicted by the mathematical model, the maximum anterior drawer force for free squatting (50 N) was considerably less than for sport cord squatting (430 N). Therefore, the value of shear force at the tibiofemoral joint only partially determines the load placed on the ACL.     

Role of knee ligaments in proprioception and regulation of muscle stiffness

Physiologic evidence for the sensory role of the knee joint ligaments are reviewed. The cruciate and collateral ligaments accomodate morphologically different sensory nerve endings with different capabilities of providing the central nervous system (CNS) with information not only about noxious and chemical stimuli but also about mechanical events, e.g., movement- and position-related stretches of the ligaments. Available data show that low-threshold joint/ligament receptor (i.e., mechanoreceptor) afferents evoke only weak and rare effects in skeletomotor neurons (α-motoneurons), whereas they frequently and powerfully influence fusimotor neurons (γ-motoneurons). The effects on the γ-muscle-spindle system in the muscles around the knee are so potent that even stretches of the cruciate ligaments at relatively moderate loads (not noxious) may induce major changes in responses of the muscle spindle afferents. As the activity in the primary muscle spindle afferents modifies stiffness in the muscles, the cruciate ligament receptors may, through the γ-muscle-spindle system, participate in regulation and preparatory adjustment of the stiffness of the muscles around the knee joint and thereby of knee joint stiffness. Thus, the sensory system of the cruciate ligaments is able to contribute significantly to the functional stability of the knee joint. The possible role of (ligamentous) joint receptors in genesis and spread of muscular tension in occupational muscle pain and in chronic musculoskeletal pain syndromes is also discussed.     

Age-related changes of element contents in human mitral and tricuspid valves

To examine age-related changes of human cardiac valves, mitral and tricuspid valves were analyzed by inductively coupled plasma-atomic emission spectrometry. The subjects for mitral valves consisted of 12 men and 8 women, ranging in age from 52 to 96 yr. The subjects for tricuspid valves consisted of 11 men and 6 women, ranging in age from 52 to 93 yr. Furthermore, 16 of the samples of the cardiac valves were derived from the same subjects. The contents of calcium, phosphorus, and magnesium in the mitral valves increased progressively with advancing age and reached maximum in the 80s in regard to calcium and phosphorus and maximum in the 90s in regard to magnesium. The maximum average amounts corresponded to about three times the average contents in the 60s. In contrast, the content of sulfur in the mitral valves remained constant between the 50s and 90s. Regarding tricuspid valve, the contents of calcium, phosphorus, and magnesium scarcely increased with advancing age, except for one subject who died of chronic renal failure. Histological observations of the mitral valves revealed that deposits of calcium were present in both the elastic fibers and its degenerative tissues of the mitral valve. The present study indicates that the accumulation of calcium, phosphorus, and magnesium occurs progressively in the mitral valve with aging, but does not occur in the tricuspid valve.     

Increases of calcium and magnesium and decrease of iron in human posterior longitudinal ligaments of the cervical spine with aging

To elucidate compositional changes of ligaments with aging, the authors investigated age-related changes of elements in the posterior longitudinal ligaments (PLLs) by inductively coupled plasma—atomic emission spectrometry. After the ordinary dissection, PLLs were resected from the subjects ranging in age from 65 to 95 yr. The PLLs of the cervical spine were resected between the fourth and fifth cervical vertebrae, the PLLs of the thoracic spine between the fifth and seventh thoracic vertebrae, and the PLLs of the lumbar spine between the second and third lumbar vertebrae. Calcium and magnesium increased progressively with aging in the PLLs of the cervical spine, but they did not increase with aging in the PLLs of the thoracic and lumbar spine. In contrast, iron decreased gradually with aging in the PLLs of the cervical spine. Regarding the relationships among elements, significant correlations were found among the contents of calcium, phosphorus, magnesium, and sodium in the PLLs of the cervical spine.     

Age-related changes of elements with their relationships in human cranial and spinal nerves

To elucidate compositional changes of peripheral nerves with aging, the authors investigated age-related changes of elements and their relationships in the optic, trigeminal, vagus, median, radial, ulnar, femoral, sciatic, tibial, and common peroneal nerves by inductively coupled plasma-atomic emission spectrometry. The subjects consisted of 10 men and 12 women, ranging in age from 65 to 91 yr. It was found that although accumulations of Ca and P occurred only in the trigeminal nerve at old age, it hardly occurred in the optic, vagus, median, radial, ulnar, femoral, sciatic, tibial, and common peroneal nerves at old age. The average contents of Ca and P were three and two times higher in the trigeminal nerve than in the other nine kinds of nerve, respectively. Likewise, the average content of Mg was a little higher in the trigeminal nerve compared with the other nerves. With regard to the relationships among elements, significant direct correlations were found among the contents of Ca, P, S, and Mg in most, but not all, 10 kinds of nerve. In the trigeminal nerve, a significant inverse correlation was found between the contents of S and the other elements, such as Ca, P, and Mg. Regarding the relationships between the contents of S and other elements, the nerves, except for the trigeminal nerve, differed from those found in the arteries previously reported.     

Muscle co-contraction after anterior cruciate ligament reconstruction: Influence of functional level

Background

ACL reconstruction is recommended to improve function in subjects with ligament injuries. However, after surgery, some individuals are not able to return to their pre-injury functional level. The mechanisms related to this incapacity are not well understood.

Study design

Cross-sectional study.

Methods

Co-contraction levels were assessed in individuals who returned to their pre-injury functional level and in 10 individuals who were not able to return to full activity after unilateral ACL reconstruction. Electromyography of the vastus lateralis and biceps femoris muscles before and after sudden perturbations applied during the stance phase of walking was used to calculate co-contraction.

Results

The involved limb had lower co-contraction pre-perturbation than the non-involved limb in both groups (p = 0.049). The co-contraction level post-perturbation was significantly higher in the limited return group than in the full return group (p = 0.03).

Conclusion

Decreased co-contraction in the involved limb before perturbation may be caused by sensorial changes resulting from surgery or injury. Increased co-contraction levels observed in the limited return group after perturbation may be a compensatory mechanism to make up for possible decreased intrinsic stability of the knee joint.

Clinical relevance

Increased co-contraction after perturbation does not contribute to knee stability.     

Age-related changes of element contents in human tendon of the iliopsoas muscle and the relationships among elements

To elucidate compositional changes of the tendons with aging, the authors investigated age-related changes of element contents in the tendon of the iliopsoas muscle by inductively coupled plasma-atomic emission spectrometry. The subjects consisted of 14 men and 14 women, ranging in age from 4 to 102 yr. The insertion tendons of the iliopsoas were removed from the cadavers after ordinary dissection and also surgically from patients with congenital dislocation of the hip. It was found that both Mg and P in the tendon of the iliopsoas muscle increased significantly with aging, but the other elements, such as S, Ca, Na, Zn, Fe, and Si, hardly changed with aging. With regard to the relationship among element contents, extremely significant correlations were found between P and S contents, between Mg and Na contents, and between S and Zn contents. In addition, very significant correlations were found between Si and either S or Zn contents. However, there was no significant correlation between Ca and P contents. These results revealed that with regard to age-related changes of element contents and the relationships among element contents, the tendon of the iliopsoas muscle was different from the Achilles tendon, in which both Mg and P decreased significantly with aging and there were significant correlations each other among the contents of S, Mg, and P.     

Kinematic motion of the anterior cruciate ligament deficient knee during functionally high and low demanding tasks

The purpose of this study was to determine whether mechanical adaptations were present in patients with anterior cruciate ligament (ACL)-deficient knees during high-demand activities. Twenty-two subjects with unilateral ACL deficiency (11 males and 11 females, 19.6 months after injury) performed five different activities at a comfortable speed (level walking, ascending and descending steps, jogging, jogging to a 90-degree side cutting toward the opposite direction of the tested side). Three-dimensional knee kinematics for the ACL-deficient knees and uninjured contralateral knees were evaluated using the Point Cluster Technique. There was no significant difference in knee flexion angle, but an offset toward the knee in less valgus and more external tibial rotation was observed in the ACL-deficient knee. The tendency was more obvious in high demand motions, and a significant difference was clearly observed in the side cutting motions. These motion patterns, with the knee in less valgus and more external tibial rotation, are proposed to be an adaptive movement to avoid pivot shift dynamically, and reveal evidence in support of a dynamic adaptive motion occurring in ACL-deficient knees.     

Knee stability and muscle coordination in patients with anterior cruciate ligament injuries: An electromyographic approach

We present findings on the way in which to use electromyographic (EMG) measurements from muscles acting on the knee in planning rehabilitation of subjects after rupture of anterior cruciate ligament (ACL). ACL subjects demonstrated an earlier recruitment and a tendency to prolonged activity in muscles around the deficient knee as compared with a control group. Especially the hamstring lateralis and the gastrocnemius medialis (GM) muscles showed an earlier EMG onset and a longer EMG burst duration. The clinical relevance of the EMG findings was assessed by comparing the muscle coordination and relative levels of activity between a functionally excellent/good and a functionally poor ACL patient group. Significant differences between the two groups were noted in EMG onset and burst duration of the GM muscle. A rehabilitation program based on the EMG findings from the GM muscle was designed. In this program, the ACL subjects with poor stability were trained to change the EMG activity of the gastrocnemius muscles according to the recruitment pattern of the good/excellent ACL-group. We were able to train the subjects to change their muscle recruitment and to improve their knee stability. The stability of the knee joint depends on the stiffness of the muscles and ligaments around and within the knee. We discuss the importance of the gastrocnemius muscles with regard to knee joint stiffness.     

Mechanical stretch increases CCN2/CTGF expression in anterior cruciate ligament-derived cells

Anterior cruciate ligament (ACL)-to-bone interface serves to minimize the stress concentrations that would arise between two different tissues. Mechanical stretch plays an important role in maintaining cell-specific features by inducing CCN family 2/connective tissue growth factor (CCN2/CTGF). We previously reported that cyclic tensile strain (CTS) stimulates α1(I) collagen (COL1A1) expression in human ACL-derived cells. However, the biological function and stress-related response of CCN2/CTGF were still unclear in ACL fibroblasts. In the present study, CCN2/CTGF was observed in ACL-to-bone interface, but was not in the midsubstance region by immunohistochemical analyses. CTS treatments induced higher increase of CCN2/CTGF expression and secretion in interface cells compared with midsubstance cells. COL1A1 expression was not influenced by CCN2/CTGF treatment in interface cells despite CCN2/CTGF stimulated COL1A1 expression in midsubstance cells. However, CCN2/CTGF stimulated the proliferation of interface cells. Our results suggest that distinct biological function of stretch-induced CCN2/CTGF might regulate region-specific phenotypes of ACL-derived cells.     

Quantitation of estrogen receptors and relaxin binding in human anterior cruciate ligament fibroblasts

Summary The significantly higher incidence of anterior cruciate ligament (ACL) injuries in collegiate women compared with men may result from relative ligament laxity. Differences in estrogen and relaxin activity, similar to that seen in pregnancy, may account for this. We quantified estrogen receptors by flow cytometry and relaxin receptors by radioligand binding assay in human ACL cells and compared the presence of these receptors in males and females. ACL stumps were harvested from seven males and eight females with acute ACL injuries. The tissue was placed in M199 cell culture medium. Outgrowth cultures were obtained, and passage 2 cells were used for all studies. Estrogen receptor determination was performed using flow cytometry. Relaxin binding was performed in ACL cells derived from five female and male patients using I¹²⁵-labeled relaxin. Estrogen receptors were identified by flow cytometry in 4 to 10% of ACL cells. Mean fluorescence of cells expressing estrogen receptors was approximately twice that of controls, with no significant differences between males and females. Relaxin studies showed low-level binding of I¹²⁵-relaxin-labeled ACL cells. Relaxin binding was present in four out of five female ACL cells versus one out of five male ACL cells.