Statistical analysis of collagen alignment in ligaments by scale-space analysis

Injuries to ligaments in the knee are common in sports and other physical activities. Some clinical methods are available for qualitatively evaluating the degree of ligament injury and healing. It is, however, desirable to objectively assess the healing of ligaments and to predicate optimal treatment on quantitative measurements of their structure. Information such as areas of coverage and spatial orientations of collagen fibrils, for example, may provide important information about the internal structure of ligament tissues. Since normal ligament tissues are made up of collagen fibrils which are highly organized, they can be considered as oriented piecewise linear patterns. In this paper, we propose a computational technique for statistical analysis of collagen alignment in ligament images using the scale-space approach. In this method, a ligament image is preprocessed by a sequence of filters which are second derivatives of two-dimensional Gaussian functions with different scales. This gives a set of zero-crossing maps (the scale space) from which a stability map is generated. Significant linear patterns are captured by analyzing the stability map. The directional information in terms of orientation distributions of the collagen fibrils in the image and the area covered by the fibrils in specific directions are extracted for statistical analysis. Examples illustrating the performance of this method with scanning electron microscope images of the collagen fibrils in healing rabbit medial collateral ligaments are presented in this paper.

Immunoelectron microscopic localization of elastic tissue components in archival tissue samples

Tissue samples that have been stored for many years, in different media and under a variety of conditions, have been examined by modern techniques of immunoelectron microscopy, using antibodies against elastic tissue components. A range of postembedding restorative procedures has been identified, which will allow reliable immunolocalization of antibodies against the elastic tissue component of such specimens. These methods have been applied successfully to autopsy-derived material, fixed in buffered formaldehyde, to archival material stored frozen at -70 or -20 degrees C, to specimens fixed for electron microscopy and stored for many years in buffer, and even to archival material from formaldehyde-fixed, paraffin-embedded blocks, reprocessed for electron microscopic examination. The successful restorative methods included pre-treatment of the sections with 6 M guanidine hydrochloride, or 1 M Tris/saline, each containing 100 mM dithiothreitol (a reducing agent) followed by alkylation with 220 mM iodoacetamide. The application of these techniques allowed reliable study of elastic tissue antibody distributions in archival tissues that could not be obtained again, as well as comparative studies with tissues processed many years previously.

Intracapsular lens delivery during attempted extracapsular cataract extraction. Association with capsulorrhexis

Continuous circular tear capsulotomy, or capsulorrhexis, has become a popular technique in cataract extraction, especially in phacoemulsification. The authors report on six cases from five different surgeons at three institutions, in which the entire lens was inadvertently delivered on attempted expression of the nucleus after circular capsulorrhexis. In one case, scanning electron microscopy suggests that the smooth edge of a small, closed, capsular tear is not capable of controlled extension to allow nuclear egress. Therefore, superior radial anterior capsular relaxing incision is recommended when circular capsulorrhexis is used in extracapsular cataract extraction.

Extraction of extendable beaded structures and their identification as fibrillin-containing extracellular matrix microfibrils

High molecular weight aggregates were extracted from human amnion using buffers containing 6 M guanidine hydrochloride. Rotary shadowed preparations and negatively stained samples examined by electron microscopy showed that each aggregate appeared to be a string of globular structures joined by fine filaments, giving the appearance of beads on a string. The periodicity of the beads was variable. A mouse monoclonal antibody directed against a previously characterized pepsin fragment of fibrillin was used with gold-conjugated secondary antibody and immunoelectron microscopy to show that the aggregates contained fibrillin. Similar structures were found in non-denaturing homogenates of skin, tongue, ligament, ciliary zonule, cartilage, and vitreous humor. When immunogold-labeled beaded structures were prepared for electron microscopy in the same manner as tissue, the beaded structures could no longer be seen. Instead, gold-labeled microfibrils were found which appeared to be the same as the fibrillin-containing matrix microfibrils observed in connective tissues and often associated with elastin. Thus, standard TEM protocols including fixation, dehydration, and embedding alter the ultrastructural appearance of microfibrils as compared with negative stain or rotary shadowing techniques. When skin was stretched and prepared for electron microscopy while still under tension, beaded filaments were seen in the tissue sections, but were not visible in non-stretched controls. In addition, when stretched ligament was immunolabeled with antibody directed against fibrillin while still under tension, the periodicity of antibodies along the microfibrils increased compared with non-stretched controls. We propose that microfibrils contain globular structures connected by fine filaments composed at lease in part of highly ordered, periodically distributed fibrillin molecules, whose periodicity is subject to change dependent on the tensional forces applied to the tissue in which they are contained.

Collagen structural organization in uncalcified and calcified human anterior longitudinal ligament

Collagen structure and collagen-apatite structural relationship has been investigated in human anterior ligament, where the mineral deposition occurs on collagen fibrils morphologically different from those of bone and tendons. Ultrastructural observations made on replicas of cryoprotected and freeze fractured uncalcified samples display a "helicoidal" morphology of the collagen fibrils. X-ray diffraction analysis carried out using conventional and synchrotron radiation sources revealed that the D-axial spacing is 65.0 nm and the electron density distribution inside the repeating period is very similar to those of tendon collagen in the same conditions of hydration. The short D-period can be interpreted as due to a greater angle of molecular crimping and/or molecular tilt compared to that of tendon. Air drying does not cause any appreciable variation in the D-axial period and induces an increase of the gap/overlap ratio that can be ascribed to telopeptide disorder. In spite of the different morphology of the collagen fibrils, the structural relationship between collagen and the mineral phase in calcified ligament is very close to that observed in bone and tendons. The apatitic phase is laid down in blocks along the collagen fibrils with the same axial periodicity, D = 65.0 nm, as that of uncalcified collagen fibrils. The mean height of the mineral blocks, which are 0.45D long, is even higher than in bone and masks any further fluctuation of the electron density due to the organic matrix.

Rotary shadowing of elastic system microfibrils in the ocular zonule, vitreous, and ligamentum nuchae

Rotary shadowing of zonular fibrils in human and bovine eyes revealed a "string of beads" configuration with multiple interconnecting filaments, identical to that recently reported in fibrils of unknown type within the vitreous. These 29 nm beaded fibrils were the only macrostructures present in zonular samples, showing ultrastructural features correlating with both the macro and microperiodicity of zonular fibrils in tissues. Interbead periodicity varied from 30-57 nm and interbead filaments appeared capable of stretching even further, possibly explaining the inherent elasticity of zonular fibrils. The junctions between outer filaments and beads were fibrillin-positive. Similar beaded fibrils were found in the human and bovine anterior vitreous along with type II and IX collagen fibrils, proteoglycan filaments and other unidentified fibrils. After collagenase and elastase digestion, bovine ligamentum nuchae showed type VI collagen fibrils and clumps of beaded fibrils like those in zonule and vitreous. This distribution indicates that the beaded fibril is the microfibril which constitutes the basic unit of the elastic system.

Ultrastructural changes of the patellar tendon as a cruciate ligament substitute (one year and two year results)

In four black-faced sheep, the posterior cruciate ligament was replaced with a free autogenous patellar tendon transplant. Tissue samples from the transplants were investigated by light and electron microscopy 1 year and 2 years after surgery. The normal contralateral posterior cruciate ligament and the normal contralateral patellar tendon were used as controls. The structural differences concerned cells, collagen fibrils, elastic tissue and proteoglycans. Most of the cells of the contralateral patellar tendon were spindle-shaped, whereas those of the transplant were frequently chondroid. In the central region of the transplant as well as in the area far from the bone, cell degenerations, and occasionally hypo- or even acellular zones were found. Measurements of the diameter of collagen fibrils in both contralateral patellar tendon and posterior cruciate ligament showed a more or less pronounced bimodal distribution. A unimodal distribution with mainly thin fibrils (20-60 nm) was demonstrated in the transplant tissue which also revealed some morphological alterations of the collagen fibrils. Thin elastic fibers (microfibrils and amorphous material) were randomly scattered among the collagen fibrils of the control samples, bundles of microfibrils (without amorphous material) characterized the transplant. Staining with Alcian blue in the presence of 0.3 M MgCl2 demonstrated a close relationship between proteoglycans and collagen fibrils as well as elastic components in patellar tendon. This arrangement was lost in the transplant where abundant proteoglycans were revealed which, however, composed a tight irregular network between the collagen fibrils. The results serve as a baseline for understanding the impaired biochemical properties of a free autogenous patellar tendon transplant.

A scanning electron microscopy morphometric study of the rabbit peritoneal surface

Rabbit peritoneum was studied by SEM to obtain information and statistically meaningful morphometric data of different sites of visceral and parietal peritoneum and to verify the existence of "stomata." Samples were fixed by intraperitoneal infusion of glutaraldehyde, and were photographed by SEM under standard conditions. Morphometric data were obtained by Kontron MOP Videoplan. Variable cell surface patterns were present even within limited areas; however, "stomata" were not observed. The heterogeneity of data obtained can be related to the dynamism of mesothelial cell activity and to the different motilities of the underlying organs.

The morphology of the equine iridocorneal angle: a light and scanning electron microscopic study

The present investigation of 20 equine eyes shows that the iridocorneal angle of the horse is characterised by a very distinct pectinate ligament and a large ciliary cleft. The pectinate ligament consists of long and broad pigmented trabeculae which form a firm, flat and dense network that encircles the eye. On meridional sections, the ciliary cleft is visible as a wide triangular space comprising the trabecular meshwork which consists of two parts. The inner part is the larger and forms a three-dimensional network of large pigmented trabeculae with very wide intertrabecular spaces. The outer part occupies a much smaller area and fills the posterior angle of the ciliary cleft. It is a compact annular network consisting of small non-pigmented circularly orientated trabeculae. They enclose very narrow spaces which contain glycosaminoglycans. External to the outer network lies the angular aqueous plexus, which is rudimentary. This discontinuous plexus runs circularly and is composed of small slit-like vessels. The intrascleral venous plexus is also very weakly developed, whereas the internal collector channels and the episcleral venous plexus are clearly visible. The large ciliary cleft is supported by the strong trabeculae of both the pectinate ligament and the inner part of the trabecular meshwork, making collapse of the ciliary cleft practically impossible. This morphology of the equine iridocorneal angle helps to explain the rarity of glaucoma in the horse.

Mechanism of failure of the ligamentum flavum of the spine during in vitro tensile tests

Thirty ligamenta flava were dissected from pig lumbar spines with their attachments to the bone of the laminae still intact. These specimens were tested to failure, in tension, at strain rates of 0.03 and 0.2 s-1. Video recordings were made of the specimens during testing. Specimens failed because the ligaments became detached from the bone. The maximum stress that the ligaments were able to transmit was approximately 3 MPa. However, the corresponding strain was higher when testing at the slower strain rate than at the faster rate; these strains were 1.6 +/- 0.5 and 1.0 +/- 0.3, respectively. All specimens were able to transmit stress after the maximum value had been attained because threads of ligament continued to remain attached to bone. Complete failure did not occur until the last of these threads had pulled away. Scanning electron micrographs showed no ligament, other than a few isolated pieces of fibre, adhering to bone after failure had occurred.

The ultrastructure of the coracoacromial ligament in patients with chronic impingement syndrome

In an ultrastructural study of the cells and matrix of the coracoacromial ligament (CAL) in 11 patients with impingement syndrome (IS), the cells appeared variegated, in contrast to those in normal CALs. Many showed degenerative changes such as lipid inclusions in the cytoplasms or swelling of cytoplasmic organelles, especially in the vicinity of fibrin exudate where the collagenous matrix disappeared. However, some cells had increased cytoplasmic organelles, including an elaborate Golgi apparatus, indicating enhanced synthetic activity. The matrix, instead of consisting of packed collagenous fibers of fairly uniform diameter as seen in the normal CAL, contained collagen fibers of varying diameters and microfibrils. The ultrastructural features of both the cells and the matrix were suggestive of chronic effects of strain on the ligament. In patients with chronic IS, the CAL has been implicated as the likely cause of impingement when no significant bony or articular abnormality exists. This was not substantiated by the present findings. The changes in the CAL in IS are possibly secondary, and are probably induced by alterations in soft-tissue structures of the subacromial compartment.

The early effect of high molecular weight hyaluronan (hyaluronic acid) on anterior cruciate ligament healing: an experimental study in rabbits

The purpose of this study was to assess, morphologically and biochemically, the effect of hyaluronan (HA) on the early repair process of the anterior cruciate ligament (ACL). Following partial bilateral laceration in the midsubstance of the cruciate ligament, a single dose of HA (MW of 3.6 x 10(6] was injected in one knee and saline in the contralateral knee. Postsurgery, the rabbits were allowed normal (nonimmobilized) cage activity, and were killed after 4 (n = 11) and 12 (n = 10) weeks. The ligaments were evaluated by gross morphology and graded according to the degree of repair. We used grades 1,2, and 3 for uncovered, partially covered, and totally covered lacerations, respectively. Five of the HA-treated ligaments at each time studied were completely covered, compared to 0 at 4 weeks, and 1 at 12 weeks in the saline group. Paired evaluations of the lacerated ACLs showed that the HA-treated ligaments received a healing grade higher than the ligaments exposed to saline in 14 of the 21 animals. In the remaining animals, there was no difference between the sides. The repaired tissue of the ACLs was also examined by light and electron microscopy. When compared qualitatively with saline controls, HA-treated ligaments exhibited a more pronounced repair, with an increased angiogenesis and less inflammatory response. Biochemical analysis demonstrated a mean higher value of type III collagen in the HA-treated injured ACL than in saline-treated injured ACL (13.4 +/- 1.1% and 11.0 +/- 0.8%, respectively). This increased synthesis of type III collagen in the HA-treated injured ACL was statistically higher (p less than 0.05) when compared to the saline-treated injured ACL.

Ultrastructure of the human interspinous ligament and ligamentum flavum. A preliminary study

The ultrastructure of ligamenta flava (LF) and interspinous ligaments (ISL) obtained from four patients who underwent surgery for vertebral fracture (control group) and five patients operated for disc herniation was studied. The fine structure of LF was composed of elastic and elaunin fibers. Small diameter collagen fibrils were found between the elastic system fibers. The ISL was constituted predominantly of collagen fibrils. Elastic fibers were seen in the most ventral part of the ligament. In ISL and LF of the control group, the cells were fibroblastic-like cells. Chondrocytes were present only near their attachment sites. The proteoglycans were demonstrated between the collagen fibrils, and they appeared to form a regular interfibrillar linking. In ligaments obtained from patients with disc herniation, several modifications were found. The fibroblasts transformed into chondrocytic cells, which were surrounded by a pericellular matrix rich in proteoglycan filaments. A few cells that had suffered necrosis were found. Alterations in the collagen-proteoglycans arrangement also were evidenced. The proteoglycan filaments were randomly oriented to the collagen fibrils.

A scanning electron microscopic study of rabbit ligaments under strain

For the purpose of determining the critical strain level for ligaments submitted to mechanical stimulation, rabbit medial collateral ligaments (MCLs) were subjected to different predetermined strain levels and then examined by scanning electron microscopy (SEM). Below 10% strain no evidence of disruption of the collagenous entities has been found. At about 10% strain, the ligaments were still intact macroscopically but SEM revealed numerous broken thin collagen fibers. At 20% strain, ruptures of thick collagen fibers bundles (5 to 10 mu in diameter) were found. These findings suggest that when using mechanical stimulation of ligaments, care must be taken to not exceed 10% strain level.

Spiral ligament tension fibroblasts and extracellular fibres in the guinea pig

Fibroblasts with stress fibres and their relationship to extracellular matrix fibres were described in the marginal regions of the spiral ligament in several mammalian species. Location, structure and attachment of these cells suggested that they facilitated the development of radial tension in the basilar membrane-spiral ligament complex. In this study, fibroblast structure and relationship with the extracellular matrix was examined by light and transmission electron microscopy in the guinea pig spiral ligament. Tension fibroblasts were found in marginal and subcentral regions of the spiral ligament. Their ultrastructure was described. They were related to the trabeculated extracellular matrix and were numerous in the marginal region at the spiral ligament-otic capsule interface. Their comparative anatomy and role in the development of spiral ligament-otic capsule tension was discussed.

The ligamentum infundibulo-cornuale in the pig: morphological and physiological studies of the smooth muscle component

The ligamentum infundibulo-cornuale (LIC) in the pig runs along the anterolateral side of the tubal isthmus, connecting the uterotubal junction and the edge of the infundibulum and has a comparatively well-developed muscular component running under the mesothelium. The well-vascularized smooth muscle cells held close cell-to-cell contacts and received innervation by adrenergic and cholinergic-like nerve terminals. Isolated LIC preparations, collected during oestrus showed a rhythmic spontaneous motility in vitro, the frequency and the relative amplitude of the contractions being highest during the preovulatory period. In vitro, noradrenaline and adrenaline elicited contractile (alpha) and relaxatory (beta) responses, while isoprenaline induced only beta-responses, as demonstrated by pretreatment with selective blockers. Oxytocin, PGF2 alpha and PGE2 always increased the muscular activity of the LIC. Indomethacin inhibited, in a concentration-dependent and reversible manner, the spontaneous motility of the porcine LIC, which could be fully restored by PGF2 alpha, indicating an endogenous local synthesis of prostaglandins in the tissue. The present results suggest that, in the pig, the LIC consists of a well-arranged, richly innervated bulk of smooth muscle which shows rhythmic spontaneous activity at the time of ovulation that could assist ova pick-up.

[Study of the microscopic structure of the posterior ligaments of the lumbar spine]

Biopsies of supraspinous ligaments (SSL), interspinous ligaments (ISL) and ligamenta flava (LF), removed at operation from 12 patients aged from 17 to 77 years, were examined by light microscopy, scanning electron microscopy and transmission electron microscopy. The structure of normal ligaments was first established, and then a comparison between normal and pathological ligaments was made. It was found that the SSL and ISL were composed of collagen, while the LF contained predominantly elastic fibres. In normal ligaments, a helical arrangement of the collagen fibrils was found. The fascicles were characterized by a regular waviness. Proteoglycan filaments were demonstrated in the three types of ligaments, forming a regular interfibrillar linking between adjacent collagen fibrils. Degenerative changes were found in most of the ligaments obtained from patients with disc herniation. On light microscopy, metaplasia into fibrocartilage and calcification was commonly seen. Ultrastructurally, the flattened fibroblasts were replaced by chondrocytic cells, and an accumulation of proteoglycans with a random arrangement and a cellular necrosis was encountered. The relevance of these degenerative changes to the mechanical properties and to low back pain is discussed.

Structure and mechanical properties of the longitudinal ligaments and ligamentum flavum of the spine

Stress-strain curves were recorded from anterior and posterior longitudinal ligaments and ligamenta flava dissected from pig lumbar spines. Ligaments were examined during extension by light microscopy, to observe crimp structure, and by X-ray diffraction, to determine collagen fibril orientations. Scanning electron microscopy (SEM) was used to examine ligaments fixed at high and low strains. Initial stages of ligament extension involved alignment of collagen fibrils. Collagen fibrils in unstrained ligamentum flavum were much more disoriented than in the longitudinal ligaments. Thus, fibril alignment, and consequent stiffening, occurred at much higher strains than for longitudinal ligaments, allowing ligamentum flavum to exploit the extensibility of its elastin.

Degeneration of the human lumbar spine ligaments. An ultrastructural study

The fine structural alterations in human lumbar spine ligaments were studied in tissue samples obtained from 8 young patients operated upon for idiopathic scoliosis and from 10 adult patients operated upon for herniated discs. The ultrastructure of the scoliotic ligaments was found to be normal. The majority of cells encountered were the fibroblastic-like cells. The collagen-proteoglycans interaction was similar to that described in other normal soft tissues. However, two forms of degenerative changes were demonstrated in posterior ligaments of patients with herniated discs. Metaplasia of ligamentous tissue into fibrocartilage was a common finding. The fibroblasts were replaced by chondrocytes. A few cells which had suffered necrosis were found. Alterations in the collagen-proteoglycans arrangement were also evidenced. This form of degeneration resembled that commonly associated with wear and tear phenomena. A second form of degeneration due to ageing was found to coexist with the aforementioned alterations.

The protein components of the 12-nanometer microfibrils of elastic and nonelastic tissues

A procedure has been developed which is much more specific for the solubilization of the elastin-associated microfibrils from fetal bovine nuchal ligament using treatment with reductive saline in place of reductive guanidine hydrochloride buffer. When analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, reductive saline extracts were shown to contain only five major protein bands with Mrs of 340,000, 78,000, 70,000, 31,000, and 25,000. The 31-kDa species was identified immunologically as the previously described macromolecule named microfibril-associated glycoprotein (MAGP) (Gibson, M. A., Hughes, J. L., Fanning, J. C., and Cleary, E. G. (1986) J. Biol. Chem. 261, 11429-11436). The proteins were purified by gel permeation, ion exchange, and affinity chromatography. Amino acid analyses showed that each protein had a profile which was distinct from that of MAGP although each was also high in acidic amino acids and cystine. The 340- and 78-kDa species were each demonstrated by immunoelectron microscopy with affinity-purified antibodies to be derived from the elastin-associated microfibris, and these were provisionally named microfibrillar protein 340 (MP340) and microfibrillar protein 78 (MP78), respectively. Each of the above antibodies gave a tissue distribution identical to that of anti-MAGP antibodies, and thus MP340 and MP78 also were identified with the 12-nm microfibrils of nonelastic tissues. MP340 was shown to absorb out completely the microfibrillar immunoreactivity of anti-(reductive guanidine hydrochloride extract) antibodies, indicating that MP340 was (a) the major microfibrillar constituent in these extracts and (b) the second unidentified microfibrillar antigen described previously. The relationship of the 70- and 25-kDa proteins to microfibrils is yet to be established. Immunoblot and immunoabsorption studies showed that MAGP and MP78 were immunologically related to MP340 but not to each other. Cyanogen bromide peptide mapping indicated that MAGP was structurally related to MP340. It is postulated that MAGP and MP78 are constituents of MP340 which in turn is the subunit of which the 12-nm microfibrils are composed.

Calcium pyrophosphate dihydrate crystal deposition disease in the cervical ligamentum flavum

The authors describe three cases of cervical radiculomyelopathy caused by calcium pyrophosphate dihydrate crystal deposition disease (CPPDcdd). Radiological investigations revealed nodular calcifications, 5 to 7 mm in diameter, in the cervical ligamentum flavum compressing the spinal cord. Light microscopic, scanning electron microscopic, and x-ray diffraction studies were performed on all three surgical specimens obtained by laminectomy. In two of the cases x-ray microanalysis and transmission electron microscope studies were also performed. This study defined the presence of two patterns of crystal deposition in the ligamentum flavum. One is a nodular deposit, in which hydroxyapatite crystals are seen in the central part of the nodules, with calcium pyrophosphate dihydrate (CPPD) being distributed thinly around them. The other pattern is a linear deposit seen in multiple ligaments and composed of pure CPPD, which causes minimal thickening of the ligaments. A transitional pattern between the two types was also observed. This study revealed details of the nodular deposition of crystals in the ligamentum flavum and demonstrates that CPPDcdd and so-called "calcification of the ligamentum flavum" are the same disease: namely, CPPDcdd. Hydroxyapatite is assumed to have been transformed from CPPD.

Ultrastructural aspects of freeze-fractured and etched elastin

The ultrastructural organization of fresh and purified elastin from beef ligamentum nuchae was studied by means of the freeze-etching technique. Both fresh and purified elastin showed a regular three-dimensional network of filaments which seemed to be composed of a sequence of globular subunities. There were also areas, along the regular network, in which ridges of various lengths, packed with perpendicular side filaments, were visible. In replicas of deep-etched and rotary-shadowed specimens, a thicker and more defined three-dimensional network was observable. A great variability in appearance among the globular subunits of the filaments was noticed which was at least partially due to the etching treatment. By means of computerized simulation of replicas of various hypothetically collapsed globular structures, we obtained patterns which were superimposable on those obtained in the replicas of the specimens analyzed. It is thus assumed that each globular subunit of the filament, being subjected to collapsing, has a less dense central core.

Ultrastructural study of calcification process in the ligamentum flavum of the cervical spine

The ultrastructure of the formation of calcified nodules in three cases of symptomatic calcification of the cervical ligamentum flavum were studied. In some areas of the ligament, extracellular plasma membrane-invested matrix vesicles and thick wall-bound matrix giant bodies with or without mineralized deposits were present. These calcified vesicles and bodies were also encountered in the wide mineralized areas among the collagen and elastic fibers in the ligament. The mineralization process of the calcified nodules in the ligamentum flavum implies that matrix vesicles and matrix giant bodies acquire mineralized precipitates; then some gather in clusters. Calcified deposits may spread to collagen and elastic fibers contiguous with the calcified vesicles and bodies, and some eventually coalesce to make a calcified nodule.