Terminações nervosas e suprimento vascular em tendão semitendíneo de crianças com paralisia cerebral / Nerve endings and vascular supply in semitendinosus tendon of cerebral palsy children

Objetivo: Avaliar a distribuição de substância P (SP) e imunorreatividadedo peptídeo S-100, bem como o suprimento vascular de tecidoscomumente usados como enxertos na reconstrução do ligamentocruzado anterior (LCA). Um segundo objetivo foi comparar a distribuiçãoacima mencionada nos tendões do músculo semitendíneo depacientes com paralisia cerebral (PC) com os tendões do músculosemitendíneo e tendões patelares de pacientes sem PC. Métodos:O primeiro grupo era composto por 14 crianças com paralisia cerebral,com média de idade de 11,7 anos. No momento da operaçãode alongamento dos isquiotibiais, uma amostra de músculo semitendíneofoi retirada para análise. O segundo grupo era composto por20 pacientes tratados por ruptura isolada do LCA do joelho (idademédia de 32 anos). O grupo três era composto por dez pacientescom idade média de 14,3 anos tratado de recorrente luxação dapatela lateral, e de quem foi obtida uma amostra de tendão patelar.Resultado: Não houve diferenças estatisticamente significativas noque diz respeito à quantidade de fibras nervosas imunopositivas queexpressam SP ou S-100 em todos os três grupos de pacientes. Umadiferença significativa foi observada no número de vasos sanguíneosentre músculos semitendíneo do adulto e da criança, mas não entreo músculo semitendíneo e o tendão patelar das crianças. Conclusão:O número de nociceptores, bem como de fibras proprioceptivas, ésemelhante em pacientes com PC e pacientes de uma populaçãoneurologicamente saudável. Nível de Evidência IV, Série de Casos.

Objective: To evaluate the distribution of SP (substance P) andS-100 peptide immunoreactivity, as well as the vascular supplyof tissues commonly used as grafts for anterior cruciate ligament(ACL) reconstruction. A second aim was to compare the abovementioned distribution in the semitendinosus muscle tendonsof cerebral palsy (CP) patients with the semitendinosus muscletendons and patellar tendons of patients without CP. Methods:The first group consisted of 14 children with cerebral palsy witha mean age of 11.7 years old. At the time of hamstring lengtheningoperation, a sample of semitendinosus muscle was takenfor analysis. The second group comprised 20 patients treated forisolated ACL rupture of the knee (mean age 32 years old). Groupthree comprised ten patients in the mean age of 14.3 years oldtreated for recurrent lateral patellar dislocation, and from whoma sample of patellar tendon was obtained. Results: No statisticallysignificant differences were demonstrated with regard to theamount of immunopositive nerve fibers expressing SP or S-100 inall 3 groups of patients. A significant difference was noted in thenumber of blood vessels between the adult and child semitendinosusmuscles, but not between the semitendinosus musclesand patellar tendon of children. Conclusion: The number of nociceptorsas well as proprioceptive fibers is similar in patients withCP and patients from a neurologically healthy population. Levelof Evidence IV, Cases Series.

NERVE ENDINGS AND VASCULAR SUPPLY IN SEMITENDINOSUS TENDON OF CEREBRAL PALSY CHILDREN.

OBJECTIVE: To evaluate the distribution of SP (substance P) and S-100 peptide immunoreactivity, as well as the vascular supply of tissues commonly used as grafts for anterior cruciate ligament (ACL) reconstruction. A second aim was to compare the above mentioned distribution in the semitendinosus muscle tendons of cerebral palsy (CP) patients with the semitendinosus muscle tendons and patellar tendons of patients without CP. METHODS: The first group consisted of 14 children with cerebral palsy with a mean age of 11.7 years old. At the time of hamstring lengthening operation, a sample of semitendinosus muscle was taken for analysis. The second group comprised 20 patients treated for isolated ACL rupture of the knee (mean age 32 years old). Group three comprised ten patients in the mean age of 14.3 years old treated for recurrent lateral patellar dislocation, and from whom a sample of patellar tendon was obtained. RESULTS: No statistically significant differences were demonstrated with regard to the amount of immunopositive nerve fibers expressing SP or S-100 in all 3 groups of patients. A significant difference was noted in the number of blood vessels between the adult and child semitendinosus muscles, but not between the semitendinosus muscles and patellar tendon of children. CONCLUSION: The number of nociceptors as well as proprioceptive fibers is similar in patients with CP and patients from a neurologically healthy population. Level of Evidence IV, Cases Series.

Phenomenon of painless knee in recurrent patellar dislocation in children.

INTRODUCTION: Cartilage lesion with patellar malalignment may be correlated with pain. Situations in which patients with recurrent patellar dislocation are painless between episodes of luxation can be approached with considerable curiosity. We evaluated the distribution of substance-P and S-100 protein expression in soft tissue of the knee in children with recurrent patellar dislocation, in order to evaluate the distribution of nociceptors and determine tissue origins of this situation. MATERIAL AND METHODS: Samples were collected from the medial and lateral synovial membrane, medial and lateral patellar retinaculum, Hoffa's body, patellar ligament, and quadriceps' aponeurosis in 10 children during the Blauth procedure and 10 adults with idiopathic osteoarthritis during total joint alloplasty. The density of nociceptive fibres was compared in the children and adults using S-100 and substance-P monoclonal antibodies. RESULTS: Statistical differences between groups were demonstrated for S-100 expression in synovial membrane of the medial knee compartment (p < 0.05) and for substance-P expression in the medial patellar retinaculum (p < 0.05) and synovial membrane of the lateral (p < 0.05) and medial (p < 0.05) knee compartment in favour of children. CONCLUSIONS: Lack of pain sensations in patients with recurrent patellar dislocation may be associated with non-increased expression of nerve endings in Hoffa's body. Increased expression of either S-100 protein or substance-P in synovial membrane and the medial retinaculum did not induce pain development in the knee joints of that group of patients.

Hip joint pain in children with cerebral palsy and developmental dysplasia of the hip: why are the differences so huge?

BACKGROUNDS: Non-traumatic hip dislocation in children is most often observed in the course of developmental dysplasia of the hip (DDH) and infantile cerebral palsy. The risk of pain sensations from dislocated hip joint differentiates the discussed groups of patients. Will every painless hip joint in children with cerebral palsy painful in the future? METHODS: Material included 34 samples of joint capsule and 34 femoral head ligaments, collected during open hip joint reduction from 19 children with CP, GMFCS level V and from 15 children with DDH and unilateral hip dislocation. All the children were surgically treated.The density of nociceptive fibres was compared between the children with CP and DDH, using S-100 and substance P monoclonal antibodies. RESULTS: More frequent positive immunohistochemical reaction to S-100 protein concerned structures of the femoral head ligaments in children with CP and cartilage losses on the femoral head, when compared to the same structures in children with DDH (p = 0.010). More frequent were found positive immunohistochemical reactions for S-100 protein in the joint capsules of children with cartilage losses (p = 0.031) and pain ailments vs. the children with DDH (p = 0.027). More frequent positive reaction to substance P concerned in femoral head ligaments in CP children and cartilage lesions (p = 0.002) or with pain ailments (p = 0.001) vs. the DDH children. CONCLUSIONS: Surgical treatment of hip joint dislocation should be regarded as a prophylactics of pain sensations, induced by tissue sensitisation, inflammatory process development or articular cartilage defects.

Hip joint pain in spastic dislocation: aetiological aspects.

AIM: Children with severe forms of cerebral palsy (CP) are at high risk of hip joint displacement. Various studies have found that the pain from affected joints occurs in 40 to 84% of studied individuals. The purpose of this study was to establish a correlation between the density of nociceptors localized in selected areas of the spastic dislocated hip joint and clinical evidence of hip joint pain in children with CP. METHOD: Nineteen samples of articular capsule and 19 samples of teres ligaments, collected during open hip joint reduction from 19 non-ambulatory children with spastic CP (Gross Motor Function Classification System level V; mean age 9y 6mo; 10 males, nine females), were studied. Pain was assessed using the numeric rating scale completed by caregivers. The density of nociceptive fibres was compared between the children with painful and children with painless hip joints, using S-100 and substance P monoclonal antibodies. RESULTS: The presence of S-100 protein and substance P were significantly increased (p=0.024 and p=0.02 respectively) in the children with painful hip joints. There were significantly positive correlations between the intensity of pain and the density of nerve fibres with S-100 protein (teres ligament, p=0.001; joint capsule, p=0.032) as well as substance P (teres ligament, p=0.001). INTERPRETATION: Direct and indirect inflammatory factors, present in dislocated hip joints with cartilage damage in children with spastic CP, lead to hip joint sensitization.