Skutek M, van Griensven M, Zeichen J, Brauer N, Bosch U
Laboratory of Histology and Cell Biology, Department of Traumasurgery, Hanover Medical School, 30623 Hanover, Germany.
Knee Surg Sports Traumatol Arthrosc. 2001 Sep;9(5):322-6. doi: 10.1007/s001670100217.
Accelerated rehabilitation after tendon and ligament injuries is widely accepted to avoid adverse effects of immobilization. However, progressive rehabilitation may also lead to an excessive inflammatory soft tissue response. To investigate the amount of loading necessary to accelerate the healing process without causing damage to the healing tissue, we experimentally stretched human tendon fibroblasts of healthy tendons 15 and 60 min with 1 Hz and an elongation of 5% and measured the secretion of interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha), transforming growth factor beta1 (TGF-beta1), platelet-derived growth factor (PDGF), and fibroblast growth factor basic (bFGF). Secretion of IL-6 was significantly induced by 15 min of cyclic biaxial mechanical stretching after 4 and 8 h observation time and by 60 min stretching and 2 h observation time. The growth factors TGF-beta1, bFGF, and PDGF were secreted by human tendon fibroblasts both in stretched cells and controls; however, no increases were related to mechanical stretching. There was no measurable secretion of TNF-alpha in human tendon fibroblasts. These findings suggest that the inflammatory reaction often seen during physiotherapy after tendon and ligament injuries is caused in part by secretion of IL-6 from the stretched human tendon fibroblasts. IL-6 may cause exaggerated proliferation of fibroblasts and synovial cells as seen in rheumatoid arthritis and arthrofibrosis. However, physiological proliferative reactions leading to repair of injured tissue are also possible. IL-6 measured in the synovial fluid may be an important predictor for monitoring and improving therapeutic strategies in terms of tendon/ligament healing.
肌腱和韧带损伤后的加速康复已被广泛接受，以避免固定的不良影响。然而，渐进性康复也可能导致过度的炎症性软组织反应。为了研究在不损伤愈合组织的情况下加速愈合过程所需的负荷量，我们用1Hz的频率和5%的伸长率对健康肌腱的人肌腱成纤维细胞进行了15分钟和60分钟的实验性拉伸，并测量了白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、转化生长因子β1（TGF-β1）、血小板衍生生长因子（PDGF）和成纤维细胞生长因子碱性（bFGF）的分泌情况。在观察4小时和8小时后，15分钟的循环双轴机械拉伸以及60分钟的拉伸和2小时的观察时间均显著诱导了IL-6的分泌。生长因子TGF-β1、bFGF和PDGF在拉伸细胞和对照中的人肌腱成纤维细胞中均有分泌；然而，其分泌增加与机械拉伸无关。人肌腱成纤维细胞中未检测到TNF-α的分泌。这些发现表明，肌腱和韧带损伤后物理治疗期间常见的炎症反应部分是由拉伸的人肌腱成纤维细胞分泌IL-6引起的。IL-6可能导致成纤维细胞和滑膜细胞过度增殖，如类风湿性关节炎和关节纤维化中所见。然而，导致损伤组织修复的生理增殖反应也是可能的。滑膜液中检测到的IL-6可能是监测和改进肌腱/韧带愈合治疗策略的重要预测指标。
