Per Swärd, Department of Orthopaedics, Lund University, BMC C12, SE-221 84 Lund, Sweden.
Am J Sports Med. 2014 May;42(5):1096-102. doi: 10.1177/0363546514524924. Epub 2014 Mar 24.
Osteochondral fractures are often seen on magnetic resonance imaging (MRI) of acutely injured knees, but their existence has gained little interest because of a lack of knowledge of their relation to treatment options and outcome. It is not clear whether acute phase synovial fluid (SF) concentrations of cartilage and bone markers and proinflammatory cytokines are different between traumatically injured knees with or without osteochondral fracture.
Acutely injured knees with an osteochondral fracture, particularly fractures with disrupted cortical bone, have higher concentrations of bone markers and cytokines than do knees without an osteochondral fracture.
Cross-sectional study; Level of evidence, 3.
Synovial fluid (hemarthrosis) was aspirated (median 1 day after injury) and 1.5-T MRI was performed (median 8 days after injury) in the acutely injured knee of 98 individuals (26% women; mean age, 23 years). As visualized on MRI, 39% knees had an osteochondral fracture with disrupted cortical bone, 30% had an osteochondral fracture with intact cortical bone, and 32% did not have an osteochondral fracture. Concentrations of sulfated glycosaminoglycan, ARGS aggrecan, cartilage oligomeric matrix protein, osteocalcin, secreted protein acidic and rich in cysteine (SPARC), osteopontin and proinflammatory cytokines (interleukin [IL]-1β, IL-6, IL-8, and tumor necrosis factor [TNF]-α) were analyzed.
After adjusting for days between injury and SF aspiration, age at injury, and sex, knees with any osteochondral fracture (with or without disrupted cortical bone) had significantly higher SF concentrations of TNF-α (median [interquartile range (IQR)] = 9 [7-12] pg/mL vs. 7 [5-14] pg/mL; P = .013), whereas knees with an osteochondral fracture with disrupted cortical bone had significantly higher SF concentrations (medians [IQRs]) of SPARC (492 [328-754] ng/mL vs. 407 [140-685] ng/mL; P = .030), IL-8 (278 [148-628] pg/mL vs. 138 [67-413] pg/mL; P = .028), and TNF-α (11 [7-15] pg/mL vs. 7 [5-14] pg/mL; P = .004) compared with knees without an osteochondral fracture.
In acutely injured knees with hemarthrosis, a concomitant osteochondral fracture with disrupted cortical bone is associated with a higher degree of joint inflammation.
急性膝关节损伤的磁共振成像（MRI）常可见骨软骨骨折，但由于对其与治疗选择和结果的关系缺乏了解，这些骨折并没有引起太多关注。目前尚不清楚外伤性膝关节骨软骨骨折与无骨软骨骨折患者的急性滑液（SF）中软骨和骨标志物及前炎性细胞因子的浓度是否存在差异。
伴有骨软骨骨折，特别是伴有皮质骨中断的骨折的急性膝关节，其骨标志物和细胞因子浓度高于无骨软骨骨折的膝关节。
横断面研究；证据水平，3 级。
对 98 名个体（26%为女性；平均年龄 23 岁）急性膝关节损伤后 1 天（中位数）行关节腔抽吸（关节积血），并于 8 天（中位数）内行 1.5-T MRI 检查。MRI 可见 39%的膝关节存在皮质骨中断的骨软骨骨折，30%存在皮质骨完整的骨软骨骨折，32%无骨软骨骨折。分析了硫酸化糖胺聚糖、ARGS 聚集蛋白聚糖、软骨寡聚基质蛋白、骨钙素、富含半胱氨酸的酸性分泌蛋白（SPARC）、骨桥蛋白和前炎性细胞因子（白细胞介素[IL]-1β、IL-6、IL-8 和肿瘤坏死因子[TNF]-α）的浓度。
调整损伤至 SF 抽吸的天数、损伤时的年龄和性别后，存在任何骨软骨骨折（无论皮质骨是否中断）的膝关节 SF 中 TNF-α 的浓度明显更高（中位数[四分位数间距（IQR）]为 9[7-12]pg/mL 比 7[5-14]pg/mL；P =.013），而皮质骨中断的骨软骨骨折膝关节 SPARC（中位数[IQR]）SF 浓度更高（492[328-754]ng/mL 比 407[140-685]ng/mL；P =.030）、IL-8（278[148-628]pg/mL 比 138[67-413]pg/mL；P =.028）和 TNF-α（11[7-15]pg/mL 比 7[5-14]pg/mL；P =.004）的浓度也更高。
在伴有关节积血的急性膝关节损伤中，合并皮质骨中断的骨软骨骨折与更严重的关节炎症有关。
