Brown Christopher A, Toth Alison P, Magnussen Bob
Department of Orthopedic Surgery, Duke University Medical Center, Box 3970, 200 Trent Dr, Durham, NC 27710, USA.
Orthopedics. 2010 Dec 1;33(12):877. doi: 10.3928/01477447-20101021-09.
Postoperative inflammation and stiffness, as well as the struggle to achieve full range of motion (ROM), following knee surgery is a significant clinical challenge. Interleukin-1 is a crucial mediator of the inflammatory response and development of pathological conditions leading to chronic inflammation. We hypothesized that intra-articular injection of intra-articular anakinra, an IL-1 antagonist, would result in sustained improvements of chronic refractory arthrofibrosis and limited arthrofibrosis of the knee joint. We retrospectively reviewed 8 patients who underwent injection of intra-articular anakinra, 200 mg. Four patients (3 women, 1 man) had intra-articular anakinra for treatment of chronic refractory arthrofibrosis, and 4 patients (4 women) had intra-articular anakinra for limited arthrofibrosis. All 4 of the refractory arthrofibrosis patients had failed conservative treatment with intensive physical therapy, corticosteroid injections, and anti-inflammatory medication. Three of the 4 patients had failed a prior manipulation under anesthesia with lysis of adhesions. All 4 reported improvement in ROM (10°-45°) and swelling, with 75% reporting improvement in pain. Seventy-five percent of these patients returned to prior activity level. All 4 of the limited arthrofibrosis also failed similar attempts at conservative treatment, and 2 of the 4 had failed a prior manipulation under anesthesia with lysis of adhesions. After intra-articular anakinra, all 4 reported improvement in ROM (20°-45°) and swelling, with 80% reporting improvement in pain. Seventy-five percent of these patients were able to return to prior activity level. We found intra-articular anakinra to be effective in this small cohort of patients with refractory arthrofibrosis and limited arthrofibrosis.
膝关节手术后的炎症、僵硬以及实现全关节活动度（ROM）的困难是一项重大的临床挑战。白细胞介素-1是炎症反应和导致慢性炎症的病理状况发展的关键介质。我们假设关节腔内注射白细胞介素-1拮抗剂阿那白滞素可使慢性难治性关节纤维性变和膝关节局限性关节纤维性变得到持续改善。我们回顾性分析了8例接受200mg关节腔内注射阿那白滞素的患者。4例患者（3例女性，1例男性）接受关节腔内注射阿那白滞素治疗慢性难治性关节纤维性变，4例患者（4例女性）接受关节腔内注射阿那白滞素治疗局限性关节纤维性变。所有4例难治性关节纤维性变患者均接受强化物理治疗、皮质类固醇注射和抗炎药物等保守治疗失败。4例患者中有3例曾在麻醉下进行粘连松解术但失败。所有4例患者均报告关节活动度改善（10°-45°）和肿胀减轻，75%的患者报告疼痛改善。这些患者中有75%恢复到了之前的活动水平。所有4例局限性关节纤维性变患者同样接受类似保守治疗尝试失败，4例中有2例曾在麻醉下进行粘连松解术但失败。关节腔内注射阿那白滞素后，所有4例患者均报告关节活动度改善（20°-45°）和肿胀减轻，80%的患者报告疼痛改善。这些患者中有75%能够恢复到之前的活动水平。我们发现关节腔内注射阿那白滞素对这一小群难治性关节纤维性变和局限性关节纤维性变患者有效。
