Åhlén Martina, Roshani Leyla, Lidén Mattias, Struglics André, Rostgård-Christensen Lars, Kartus Jüri
Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Department of Research and Development, NU-Hospital Group, Trollhättan/Uddevalla, Sweden.
Am J Sports Med. 2015 Jun;43(6):1460-6. doi: 10.1177/0363546515574059. Epub 2015 Mar 18.
Patients who sustain an acute anterior cruciate ligament (ACL) rupture are at increased risk to develop posttraumatic arthritis (PTA) in the injured knee whether the ACL is reconstructed or treated nonoperatively. Inflammatory cytokines and cartilage degradation biomarkers are elevated at the time of acute injury and postoperatively. This suggests that one mechanism for PTA may be an inflammatory degradative process initiated on the acute injury and sustained for some length of time independent of whether adequate joint stability is restored.
Inflammatory cytokines and biomarkers of cartilage degradation are elevated in the synovial fluid several years after reconstruction of the ACL, indicating an ongoing imbalance between extracellular matrix destruction and repair.
Cross-sectional study; Level of evidence, 3.
In 11 patients who had undergone ACL reconstruction 8 years earlier, knee synovial fluid was aspirated from the operated knee and the contralateral nonoperated knee. The synovial fluid was analyzed for interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, sulfated glycosaminoglycans (sGAG), aggrecan neoepitope fragment (ARGS-aggrecan), and cartilage oligomeric matrix protein (COMP). At follow-up, the patients underwent bilateral weightbearing radiographs and bilateral MRIs of their knees.
No significant differences between the operated and the contralateral knee were found for the synovial fluid concentrations of IL-1β, IL-6, TNF-α, sGAG, ARGS-aggrecan, or COMP. There were significantly more radiographically visible osteoarthritic changes in the operated knees compared with the contralateral knees. MRIs revealed that all grafts and all contralateral ACLs were intact and, furthermore, that there was significantly more meniscal and cartilage damage in the index knees than the contralateral knees.
Eight years after ACL reconstruction, there were no significant differences in inflammatory cytokines and biomarkers for cartilage degeneration between the nonoperated and the ACL-reconstructed knee, even though there were more osteoarthritic changes and meniscal and cartilage damage in the operated knee, as seen on weightbearing radiographs and MRI.
急性前交叉韧带（ACL）断裂的患者，无论ACL是通过重建还是非手术治疗，其受伤膝关节发生创伤后关节炎（PTA）的风险都会增加。炎症细胞因子和软骨降解生物标志物在急性损伤时及术后都会升高。这表明PTA的一种机制可能是在急性损伤时启动并持续一段时间的炎症降解过程，而与关节稳定性是否恢复正常无关。
ACL重建术后数年，滑液中炎症细胞因子和软骨降解生物标志物升高，表明细胞外基质破坏与修复之间持续存在失衡。
横断面研究；证据等级，3级。
对11例8年前接受ACL重建的患者，从手术侧膝关节和对侧未手术膝关节抽取膝关节滑液。分析滑液中的白细胞介素（IL）-1β、IL-6、肿瘤坏死因子（TNF）-α、硫酸化糖胺聚糖（sGAG）、聚集蛋白聚糖新表位片段（ARGS-聚集蛋白聚糖）和软骨寡聚基质蛋白（COMP）。随访时，患者接受双侧膝关节负重X线片和双侧膝关节MRI检查。
手术侧膝关节与对侧膝关节滑液中IL-1β、IL-6、TNF-α、sGAG、ARGS-聚集蛋白聚糖或COMP的浓度无显著差异。与对侧膝关节相比，手术侧膝关节在X线片上可见的骨关节炎改变明显更多。MRI显示所有移植韧带和所有对侧ACL均完整，此外，患侧膝关节半月板和软骨损伤明显多于对侧膝关节。
ACL重建术后8年，未手术膝关节与ACL重建膝关节之间，炎症细胞因子和软骨退变生物标志物无显著差异，尽管在负重X线片和MRI上可见手术侧膝关节骨关节炎改变更多，半月板和软骨损伤也更多。
