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Ligaments Do Not Emit Pain1. Scott F. Dye, MD; Department of Orthopaedic Surgery, University of California, California, 2. Geoffrey L. Vaupel, MD; Division of Orthopaedic Surgery, California Pacific Medical Center, Davies Campus, San Francisco, California and 3. Christopher C. Dye; Mira Costa College, Oceanside, California Address correspondence and reprint requests to Scott F. Dye, MD, California Pacific Medical Center, Davies Campus, 45 Castro Street, Suite 117, San Francisco, CA 94114 -------------------------------------------------- Abstract The conscious neurosensory characteristics of the internal components of the human knee were documented by instrumented arthroscopic palpation without intra-articular anesthesia. With only local anesthesia injected at the portal sites, the first author (SFD) had both knees inspected arthroscopically. Subjectively, he graded the sensation from no sensation (0) to severe pain (4), with a modifier of either accurate spatial localization (A) or poor spatial localization (B). The nature of the intra-articular sensation was variable, ranging from 0 on the patellar articular cartilage to 4A on the anterior synovium, fat pad, and joint capsule. 1. The sensation arising from the cruciate ligaments ranged from 1 to 2B in the mid-portion, and from 3 to 4B at the insertion sites. 2. The sensation from the meniscal cartilages ranged from 1B on the inner rim to 3B near the capsular margin. Innervation of most intra-articular components of the knee is probably crucial for tissue homeostasis. Failure of current intra-articular soft tissue reconstructions of the knee may be due, in part, to the lack of neurosensory restoration. Research studies of the knee designed to delineate factors that restore neurosensory characteristics of the musculoskeletal system may lead to techniques that result in true restoration of joint homeostasis and function. ----------------------------------------------------------------------------------------------- When I read this abstract, I kept thinking, why did these guys do this? Their answer was that, if they understood the neurosensory characteristics of the musculoskeletal system, then, after surgical repairs, they might be able restore normal joint function. The doctor that agreed to surgery on his knee without anesthetic graded his discomfort from zero (no sensation) to four (severe pain). The other doctors quantified whether the subject accurately located where they probed, where (A) indicates that the subject accurately located the probe and (B) indicates that he did not accurately locate the probe. 1. When they probed the articular cartilage of the Patella bone, the subject did not feel any discomfort and did not accurately locate the probe. 2. When they probed the anterior synovium, the fat pad and joint capsule, the subject correctly located the probe's location and reported severe pain. 3. When they probed the mid-portions of the Anterior and Posterior Cruciate Ligaments, the subject could not accurately locate the probe and reported minimal discomfort. 4. When they probed the insertions sites of the Anterior and Posterior Cruciate Ligaments, the subject could not accurately locate the probe and reported considerable to severe pain. 5. When they probed the inner rim of the meniscal cartilages, the subject could not accurately locate the probe and reported minimal discomfort. 6. When they probed the capsular margins rim of the meniscal cartilages, the subject could not accurately locate the probe and reported considerable discomfort. That these researchers found that, when they probed the mid-portions of the Anterior and Posterior Cruciate Ligaments, the subject could not accurately locate the probe and reported minimal discomfort, supports my belief that, when baseball pitchers microscopically tear the connective tissue fiber that make up their Ulnar Collateral Ligament, they cannot feel pain. ----------------------------------------------------------------------------------------------- |
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