Schmal Hagen, Pilz Ingo H, Henkelmann Ralf, Salzmann Gian M, Südkamp Norbert P, Niemeyer Philipp
Department of Orthopaedic Surgery, University of Freiburg Medical Center, Hugstetter Str, 55, D-79106, Freiburg, Germany.
BMC Musculoskelet Disord. 2014 May 22;15:169. doi: 10.1186/1471-2474-15-169.
Reliable data about in vivo regulation of cytokines in osteochondritis dissecans (OCD) of the ankle are still missing. Disease-specific regulation patterns were hypothesized.
28 patients with a mean age of 30.7 ± 14.8 years undergoing an arthroscopy of the ankle because of OCD were prospectively included in a clinical trial. Lavage fluids were analyzed by ELISA for levels of aggrecan, BMP-2, BMP-7, IGF-1, IGF-1R, bFGF, endoglin, MMP-13, and IL-1β. Additionally, clinical parameters and scores (FFI, CFSS, AOFAS) were evaluated and supplemented by the Kellgren Lawrence Score (KLS) for conventional X-rays and the Ankle Osteoarthritis Scoring System (AOSS) for MRI.
Grading of OCD lesions statistically significant increased with age and was higher in case of previously performed operations (p<0.03). A worse clinical function reflected by low AOFAS and CFSS scores or high FFI was associated with high grading of cartilage damage or OCD (p<0.03). Similarly, high radiological scores (KLS and AOSS) indicating progress of OA positively correlated with grading of cartilage damage and OCD. The concordance between the MRI and arthroscopic classification was overall moderate (κ=0.52). Biochemically, only IGF/IGF-1R levels were consistently negatively associated with OCD grading, ICRS score, FFI and KLS (p<0.05). Correlation data is supported by post hoc statistics.
Radiological and clinical parameters in association with synovial IGF-1/IGF-1R levels indicated an increasing joint degeneration with rising OCD stage.
German Clinical Trials Register DRKS00000365, 11/03/2008.
关于踝关节剥脱性骨软骨炎（OCD）中细胞因子体内调节的可靠数据仍然缺失。假设存在疾病特异性调节模式。
28例平均年龄为30.7±14.8岁因OCD接受踝关节镜检查的患者被前瞻性纳入一项临床试验。通过ELISA分析灌洗液中聚集蛋白聚糖、骨形态发生蛋白-2（BMP-2）、骨形态发生蛋白-7（BMP-7）、胰岛素样生长因子-1（IGF-1）、胰岛素样生长因子-1受体（IGF-1R）、碱性成纤维细胞生长因子（bFGF）、内皮糖蛋白、基质金属蛋白酶-13（MMP-13）和白细胞介素-1β（IL-1β）的水平。此外，评估临床参数和评分（功能障碍指数[FFI]、加利福尼亚大学洛杉矶分校踝关节评分[CFSS]、美国足踝外科协会评分[AOFAS]），并通过常规X线片的凯尔格伦-劳伦斯评分（KLS）和MRI的踝关节骨关节炎评分系统（AOSS）进行补充。
OCD病变分级随年龄增长有统计学意义的增加，且在既往有手术史的病例中更高（p<0.03）。AOFAS和CFSS评分低或FFI高所反映的较差临床功能与软骨损伤或OCD的高分级相关（p<0.03）。同样，表明骨关节炎进展的高放射学评分（KLS和AOSS）与软骨损伤和OCD分级呈正相关。MRI与关节镜分类之间的一致性总体中等（κ=0.52）。从生化角度看，只有IGF/IGF-1R水平始终与OCD分级、国际软骨修复协会（ICRS）评分、FFI和KLS呈负相关（p<0.05）。相关数据得到事后统计的支持。
放射学和临床参数以及滑膜IGF-1/IGF-1R水平表明，随着OCD分期的升高，关节退变加剧。
德国临床试验注册中心DRKS00000365，2008年11月3日。
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