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An in-depth exploration of the embryological development, gross structure, and microscopic features of articular cartilage. It discusses the role of Dr. Sydney M. Friedman's apparatus, the function of synovial membranes, and the cellular composition of cartilage. The text also covers the vascular supply, the role of minerals, and the metabolism of articular cartilage.
What you will learn
Typology: Lecture notes
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THE STRUCTURE AND FUNCTION OF SYNOVIAL JOINTS, WITH PARTICULAR REFERENCE TO THE MECHANISM OF THEIR LUBRICATION
by
MICHAEL STAFFORD PIPER M.D., U n i v e r s i t y of B r i t i s h Columbia, 1968
A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE
i n the Department o f Anatomy
We a c c e p t t h i s t h e s i s as c o n f i r m i n g t o the r e q u i r e d s t a n d a r d
THE UNIVERSITY OF BRITISH COLUMBIA JUNE, 1972
In p r e s e n t i n g t h i s t h e s i s in p a r t i a l f u l f i l m e n t o f the requirements f o r an advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree that the L i b r a r y s h a l l make it f r e e l y a v a i l a b l e f o r reference and s t u d y. I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e copying o f t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the Head o f my Department o r by h i s r e p r e s e n t a t i v e s. It i s understood that copying o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l gain s h a l l not be allowed without my w r i t t e n p e r m i s s i o n.
The U n i v e r s i t y o f B r i t i s h Colui Vancouver 8, Canada
Department of
( i i i ) As a r e s u l t o f t h e s e i n v e s t i g a t i o n s , i t was f o u n d t h a t t h e s y n o v i a l f l u i d s a m p l e s f r o m p a t i e n t s w i t h r h e u m a t o i d a r t h r i t i s c o n t a i n e d a s i g n i f i c a n t l y l o w e r c o n c e n t r a t i o n o f i o n i z e d s o d i u m. I t i s c o n c l u d e d t h a t t h e l o w e r c o n c e n t r a t i o n o f s o d i u m i o n s i n s y n o v i a l f l u i d o f r h e u m a t o i d a r t h r i t i s may r e s u l t i n a d i m i n u t i o n o f e l e c t r i c a l r e p u l s i v e f o r c e s a c t i n g w i t h i n s y n o v i a l j o i n t s , a n d e x p l a i n , i n p a r t , t h e c a r t i l a g e a t t r i t i o n s e e n i n t h i s d i s e a s e.
S y d n e y M. F r i e d m a n P r o f e s s o r a n d H e a d D e p a r t m e n t o f Anatomy U n i v e r s i t y o f B r i t i s h C o l u m b i a ( S u p e r v i s o r )
( i v ) TABLE OF CONTENTS THE STRUCTURE AND FUNCTION OF SYNOVIAL JOINTS, WITH PARTICULAR REFERENCE TO THEIR MECHANISM OF LUBRICATION. Page No. I n t r o d u c t i o n 1 Embryology of S y n o v i a l J o i n t s 4 Gross Anatomy o f S y n o v i a l J o i n t s 6 B l o o d and Nerve Supply o f S y n o v i a l J o i n t s 8 L i g h t and E l e c t r o n M i c r o s c o p y of S y n o v i a l J o i n t s 13 S y n o v i a l Membrane and S y n o v i a l F l u i d 18 B i o c h e m i s t r y o f A r t i c u l a r C a r t i l a g e 25 M e t a b o l i s m o f A r t i c u l a r C a r t i l a g e 28 L u b r i c a t i o n o f S y n o v i a l J o i n t s 30 C o n c l u s i o n " 37 B i b l i o g r a p h y 39
( v i )
ACKNOWLEDGEMENT
I w o u l d l i k e t o a c k n o w l e d g e t h e a s s i s t a n c e g i v e n me i n t h e p r e p a r a - t i o n o f t h i s t h e s i s. I n p a r t i c u l a r I w o u l d l i k e t o t h a n k t h e o r t h o p a e d i c s u r g e o n s a n d r a d i o l o g i s t s a t t h e V a n c o u v e r G e n e r a l H o s p i t a l f o r t h e i r a s s i s t a n c e i n o b t a i n i n g s y n o v i a l f l u i d s a m p l e s , a n d D r. G e r f r i e d G e b e r t f o r h i s t e c h n i c a l a s s i s t a n c e. I n a d d i t i o n , a p p r e c i a t i o n i s e x p r e s s e d t o D r. S y d n e y M. F r i e d m a n f o r t h e o p p o r t u n i t y t o c o n d u c t t h i s w o r k , a n d f o r h i s d i r e c t i o n a n d s u p p o r t.
X INTRODUCTION "The F a b r i c o f the J o i n t s i n the Human Body i s a S u b j e c t so much the more e n t e r t a i n i n g , as i t must s t r i k e everyone t h a t c o n s i d e r s i t a t t e n t i v e - l y w i t h an Idea o f f i n e m e c h a n i c a l C o m p o s i t i o n. Where-ever the M o t i o n o f one Bone upon a n o t h e r i s r e q u i s i t e , t h e r e we f i n d an e x c e l l e n t Apparatus f o r r e n d e r i n g t h a t M o t i o n s a f e and f r e e : We s e e , f o r I n s t a n c e , the e x t r e m i t y o f one Bone moulded i n t o an o r b i c u l a r C a v i t y , t o r e c e i v e the Head o f a n o t h e r , i n o r d e r t o a f f o r d i t an e x t e n s i v e P l a y. Both a r e c o v e r e d w i t h a smooth e l a s t i c C r u s t , t o p r e v e n t mutual A b r a s i o n ; c o n n e c t e d w i t h s t r o n g L i g a m e n t s , t o p r e v e n t D i s l o c a t i o n ; and e n c l o s e d i n a Bag t h a t c o n - t a i n s a p r o p e r F l u i d d e p o s i t e d t h e r e , f o r l u b r i c a t i n g the Two c o n t i g u o u s S u r f a c e s. So much i n g e n e r a l. " thus w r o t e W i l l i a m H u n t e r , i n 1743 i n a r e m a r k a b l e e s s a y ; "Of the S t r u c t u r e and D i s e a s e s o f A r t i c u l a t i n g C a r t i l a g e s ( 1 ) ". H i s o b s e r v a t i o n s , r e c o r d e d over two hundred y e a r s ago, were e x t r e m e l y a c u t e ; i n f a c t , h i s d e s c r i p t i o n o f t h e b l o o d s u p p l y o f j o i n t s , the " C i r c u l u s A r t i c u l i V a s c u l o s u s " has p e r s i s t e d t o the p r e s e n t t i m e. That the s y n o v i a l j o i n t s c o m p r i s e d a u n i q u e body t i s s u e e a s i l y a c c e s s i b l e t o i n v e s t i g a t i o n l e d e a r l y a n a t o m i s t s t o t h e i r s t u d y. Thus, w i t h the i n t r o d u c t i o n o f the m i c r o s c o p e , the u n i q u e h i s t o l o g i c a l a p p e a r - ance of the a r t i c u l a r c a r t i l a g e s was e s t a b l i s h e d , and c a r t i l a g e was known t o have a h i g h m a t r i x t o c e l l r a t i o ( 2 ). Much i n f o r m a t i o n on the n a t u r e of s y n o v i a l j o i n t s has been accumu- l a t e d i n r e c e n t y e a r s , and i t i s the purpose o f t h i s paper t o r e v i e w
c o n t r o l l e d p a i n l e s s m o t i o n o f t h e l i m b s. To t h i s end, n a t u r e h a s p r o - v i d e d m u s c l e s a n d g r a v i t y f o r m o t i o n a n d l i g a m e n t s a n d a r c h i t e c t u r a l d e s i g n f o r s t a b i l i t y. H o w e v e r , i t i s t h e m e c h a n i s m o f l u b r i c a t i o n i n s y n o v i a l j o i n t s t h a t h a s p r o v i d e d t h e g r e a t e s t i n t e r e s t as w e l l as t h e g r e a t e s t s o u r c e o f c o n t r o v e r s e y i n r e c e n t y e a r s. T h i s t h e s i s c o n c l u d e s w i t h a d i s c u s s i o n o f t h e v a r i o u s m e c h a n i s m s p r o p o s e d t o a c c o u n t f o r t h i s l u b r i c a t i o n ; a n d , as a r e s u l t o f r e s e a r c h c o n d u c t e d t h i s y e a r , a t h e o r y o f l u b r i c a t i o n e n h a n c e m e n t b y m o n o v a l e n t c a t i o n s w i t h i n s y n o v i a l f l u i d.
Gross Anatomy o f S y n o v i a l J o i n t s A j o i n t or a r t i c u l a t i o n i s formed where two or more bones o f the body meet one a n o t h e r. ( 1 5 , 16, 17) The c h a r a c t e r and s t r u c t u r e of j o i n t s a r e l a r g e l y d e t e r m i n e d by t h e i r f u n c t i o n. Thus, j o i n t s may be f i b r o u s as seen i n t h e s u t u r e s between c r a n i a l bones, or the syndesmosis o f the i n f e r i o r t i b i o f i b u l a r j o i n t. S e c o n d l y , j o i n t s may be c a r t i l a g i n o u s. P r i m a r y c a r t i l a g i n o u s j o i n t s e x i s t as the e p i p h y s e a l p l a t e between t h e e p i p h y s i s and d i a p h y s i s o f growing bones. As such they a r e temporary and e v e n t u a l l y o s s i f y. Secondary c a r t i l a g i n o u s j o i n t s a r e seen where the a r t i c u l a r s u r f a c e s of the bones a r e c o v e r e d w i t h h y a l i n e c a r t i l a g e and c o n n e c t e d by a d i s c o f f i b r o c a r t i l a g e. These j o i n t s a l l o w some degree of m o t i o n , and a r e found i n the median p l a n e of the body - the s t e r n o - m a n u b r i a l and i n t e r v e r t e b r a l j o i n t s and the p u b i c s y m p h y s i s. A l l o t h e r j o i n t s i n the body a r e r e f e r r e d t o as s y n o v i a l or d i a r - t h r o d i a l j o i n t s , and have common c h a r a c t e r i s t i c s. The c o n t i g u o u s bony s u r f a c e s a r e c o v e r e d w i t h a r t i c u l a r c a r t i l a g e and a r e n o t a t t a c h e d t o one a n o t h e r. The a r t i c u l a r c a r t i l a g e i s u s u a l l y h y a l i n e , however, i n the case o f membranous bone the a r t i c u l a r c a r t i l a g e i s w h i t e f i b r o c a r t i l a g e. The b a s a l l a y e r o f t h e a r t i c u l a r c a r t i l a g e i s c a l c i f i e d and f i r m l y bound t o the u n d e r l y i n g bone, the " a r t i c u l a r l a m e l l a. " The bones o f s y n o v i a l a r t i c u l a t i o n s a r e bound t o one a n o t h e r by a f i b r o u s c a p s u l e c o n s i s t i n g of a dense c o n n e c t i v e t i s s u e c u f f. G e n e r a l l y the c a p s u l e i s a t t a c h e d t o the bones n e a r the p e r i p h e r y o f the a r t i c u l a r s u r f a c e. A v a r i a b l e number o f t h i c k e n i n g s i n the c a p s u l e a r e s e e n. These l i g a m e n t s a c t t o p r e v e n t e x c e s s i v e or abnormal movements o f the j o i n t s. L i n i n g the i n n e r s u r f a c e o f the f i b r o u s c a p s u l e and a t t a c h i n g t o the a r t i c u l a r margins i s a s y n o v i a l membrane. T h i s h i g h l y s p e c i a l i z e d s t r u c t u r e
e n c l o s e s a p o t e n t i a l s p a c e ( t h e t r u e j o i n t s p a c e ) w i t h i n w h i c h i s a s m a l l amount o f " S y n o v i a " o r " S y n o v i a l F l u i d ". The j o i n t c a v i t y may be d i v i d e d , c o m p l e t e l y o r i n c o m p l e t e l y , by a f i b r o c a r t i l a g i n o u s a r t i c u l a r d i s c. T h e s e d i s c s a r e u s u a l l y a t t a c h e d t o t h e c a p s u l e a t t h e i r p e r i p h e r y , b u t a r e n o t c o v e r e d w i t h s y n o v i a l mem- b r a n e. S y n o v i a l j o i n t s a r e f u r t h e r c l a s s i f i e d a c c o r d i n g t o t h e k i n d o f m o t i o n p e r m i t t e d i n them. T h i s i s d e t e r m i n e d b y t h e s h a p e o f t h e a r t i c u l a r s u r f a c e s , t h e m u s c l e s t h a t a c t u p o n t h e j o i n t , a n d t h e l i m i t s p l a c e d o n t h e j o i n t s ' e x c u r s i o n b y t h e c a p s u l e a n d l i g a m e n t s.
The b l o o d s u p p l y o f the m e t a p h y s i s changes between f o e t a l and a d u l t l i f e. (19j 20, 21) I n the f o e t u s , the metaphysis i s s u p p l i e d by the n u t r i e n t a r t e r y a l o n e , w h i l e i n the a d u l t , the m e t a p h y s e a l a r t e r i e s s u p p l y the p e r i p h e r a l two f i f t h s of the m e t a p h y s i s , the c e n t r a l t h r e e f i f t h s s t i l l b e i n g s u p p l i e d by the n u t r i e n t a r t e r y. (22) T h i s s i t u a t i o n e x i s t s i n the " g r o w i n g end" o f l o n g bones. I n the " n o n - g r o w i n g e n d " e v e n t u a l l y a l l b l o o d d e r i v e s from the m e t a p h y s e a l a r t e r i e s. L i k e w i s e t h e r e i s a change i n the b l o o d s u p p l y of e p i p h y s e s. I n the i n f a n t , (up t o one y e a r ) , m e t a p h y s e a l v e s s e l s p i e r c e the c a r t i l a g i n o u s e p i p h y s e a l p l a t e and thus s u p p l y the b a s a l p a r t of the e p i p h y s i s. A f t e r one y e a r of age the e p i p h y s e a l p l a t e becomes i m p e r v i o u s t o these meta- p h y s e a l v e s s e l s , and i s s u p p l i e d s o l e l y by the e p i p h y s e a l v e s s e l s. (23) Thus i t can be seen t h a t the b l o o d s u p p l y o f the e p i p h y s e a l p a r t of l o n g bones, and hence t h e s u b c h o n d r a l r e g i o n i s o f v a r i a b l e o r i g i n , depending upon the age o f the bone and the s i t e o f s t u d y. T h i s f a c t may be of r e l e v a n c e i n c o n s i d e r i n g the e t i o l o g y of a v a s c u l a r n e c r o s i s of the c a p i t a l f e m o r a l e p i p h y s i s. (19) The r o l e o f the s u b c h o n d r a l e p i p h y s e a l v e s s e l s i n the n u t r i t i o n o f a r t i c u l a r c a r t i l a g e w i l l be d i s c u s s e d l a t e r , however, the v a s c u l a r anatomy of the e p i p h y s i s now deserves m e n t i o n. Many e p i p h y s e a l n u t r i e n t a r t e r i e s a r i s e from the c i r c u l u s a r t i c u l i v a s c u l a s i s and anastomose w i t h i n the e p i p h y s e s of l o n g bones. I n the immature s k e l e t o n some branches pass d i r e c t l y t o the s u b c h o n d r a l a r e a o f the c a r t i l a g i n o u s growth. p l a t e ( e p i p h y s e a l p l a t e ) , but the m a j o r i t y o f the e p i p h y s e a l a r t e r i e s pass towards the a r t i c u l a r and n o n - a r t i c u l a r s u r f a c e s of the e p i p h y s i s. As these e p i p h y s e a l n u t r i e n t a r t e r i e s pass from t h a t p a r t o f the e p i p h y s i s a d j a c e n t t o the m e t a p h y s i s towards the a r t i c u l a r s u r f a c e , they
Many o f t h e f i b e r s i n a r t i c u l a r n e r v e s a r e v a s o m o t o r a n d v a s o s e n s o r y. T h e s e s u p p l y t h e b l o o d v e s s e l s i n t h e f i b r o u s c a p s u l e a n d s y n o v i a l mem- b r a n e , a n d t h e r e b y c o n t r o l b l o o d f l o w t h r o u g h t h e j o i n t. The e l e v a t e d t e m p e r a t u r e o f t h e o v e r l y i n g s k i n i n d i s t e n d e d p a t h o l o g i c a l j o i n t s i s e v i d e n c e o f t h e common s u p p l y o f j o i n t s a n d o v e r l y i n g s k i n. ( 3 2 ) One c h a r a c t e r i s t i c o f t h e n e r v e s u p p l y t o s y n o v i a l j o i n t s i s o v e r l a p. T h a t i s , e a c h r e g i o n o f a j o i n t i n n e r v a t e d b y one n e r v e i s s u p p l i e d b y a t l e a s t one o t h e r a r t i c u l a r n e r v e. T h i s p a t t e r n o f o v e r l a p p i n g i n n e r v a t i o n may l e a d t o f a i l u r e o f p r o c e d u r e s d e s i g n e d t o d e n e r v a t e p a i n f u l a r t h r i t i c j o i n t s.
L i g h t and E l e c t r o n M i c r o s c o p y o f A r t i c u l a r C a r t i l a g e
I n r o u t i n e h i s t o l o g i c a l p r e p a r a t i o n s o f a r t i c u l a r c a r t i l a g e s chon- d r o c y t e s a r e seen t o l i e i n l a c u n a e d i s t r i b u t e d w i t h i n an abundant h y a l i n e i n t r a c e l l u l a r m a t r i x. (33) The c h o n d r o c y t e s a r e s p a r c e , even i n v e r y young c a r t i l a g e. ( 3 4 , 35) E a r l y m i c r o s c o p i s t s d e f i n e d f o u r d i s t i n c t zones i n a d u l t a r t i c u l a r c a r t i l a g e , and d e s c r i b e d d i f f e r e n c e s i n the s p a t i a l arrangement as w e l l as the c e l l u l a r morphology i n t h e s e z o n e s. (34) Zone I , the s u p e r f i c i a l or t a n g e n t i a l s t r a t u m c o n s i s t s o f f l a t t e n e d o r markedly o v o i d c e l l s l y i n g a d j a c e n t t o the s u r f a c e w i t h the l o n g a x i s o f the c e l l s p a r a l l e l t o the a r t i c u l a r m a r g i n. T h i s a r e a has a l s o been r e f e r r e d t o as the " g l i d i n g zone". (36) I n Zone I I , the i n t e r m e d i a t e or t r a n s i t i o n a l s t r a t u m , the c h o n d r o c y t e s a r e plump and o v a l and d i s t r i b u t e d i n a random f a s h i o n. Zone I I I i s r e f e r r e d t o as t h e deep o r r a d i a t e s t r a t u m. The c e l l s i n t h i s zone t e n d t o be s m a l l and r o u n d. They a r e a r r a n g e d i n s h o r t , i r r e g u l a r columns p e r p e n d i c u l a r t o the a r t i c u l a r s u r f a c e. The b a s a l l a y e r o r Zone IV i s the c a l c i f i e d s t r a t u m , and l i e s a d j a c e n t t o the s u b c h o n d r a l bony p l a t e. I n t h i s a r e a the c e l l s t e n d t o be s m a l l and i r r e g u l a r w i t h p y k n o t i c n u c l e i. On h e m a t o x y l i n and e o s i n s t a i n the c a l c i f i e d s t r a t u m i s s e p a r a t e d from t h e more s u p e r f i c i a l l a y e r s by a t h i n wavy b l u e l i n e. The n a t u r e o f t h i s b a s o p h i l i c a r e a i s unknown; i t has been c a l l e d the " t i d e m a r k ". F u r t h e r mention w i l l be made o f the v a r i a t i o n s found i n the c h o n d r o c y t e s of d i f f e r - ent zones, p a r t i c u l a r l y w i t h r e g a r d t o s t u d i e s w i t h the e l e c t r o n m i c r o s c o p e. M e n t i o n s h o u l d be made now, however, o f the l i g h t m i c r o s c o p i c appearance of t h e i n t r a c e l l u l a r m a t r i x o f a r t i c u l a r c a r t i l a g e.
