Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund, Sweden.
Osteoarthritis Cartilage. 2017 Sep;25(9):1443-1451. doi: 10.1016/j.joca.2017.05.009. Epub 2017 May 15.
Prospectively monitor how treatment of acutely ruptured anterior cruciate ligament (ACL) affects biomarkers of inflammation and proteolytic degradation over 5 years.
We studied 119 subjects with acute ACL injury from the randomized controlled knee anterior cruciate ligament, non-surgical versus surgical treatment (KANON)-trial (Clinical trial ISRCTN 84752559) who had synovial fluid, serum and urine samples available from at least two out of six visits over 5 years after acute ACL rupture. All subjects followed a similar rehabilitation protocol where, according to randomization, 60 also had early ACL reconstruction and 59 had the option to undergo a delayed ACL reconstruction if needed. Interleukin (IL)-6, IL-8, IL-10, interferon-gamma (IFNγ), tumor necrosis factor (TNF), amino acids alanine, arginine, glycine, serine (ARGS)-aggrecan, C-terminal crosslinking telopeptide type II collagen (CTX-II) and N-terminal crosslinking telopeptide type I collagen (NTX-I) were quantified by enzyme-linked immunosorbent assays (ELISA).
Subjects randomized to early ACL reconstruction had higher cytokine concentrations in index knee synovial fluid at 4 months (IL-6, IL-8, IL-10, TNF), 8 months (IL-6 and TNF) and at 5 years (IFNγ) compared to those randomized to optional delayed reconstruction. Those that underwent delayed ACL reconstruction within 5 years (30 subjects), had higher synovial fluid concentrations of IL-6 at 5 years compared to those treated with rehabilitation alone. No differences between groups were noted for ARGS-aggrecan in synovial fluid and serum or CTX-II and NTX-I in urine over 5 years, neither as randomized nor as treated.
Surgical ACL reconstruction constitutes a second trauma to the acutely injured joint resulting in a prolonged elevation of already high synovial fluid levels of inflammatory cytokines.
前瞻性监测急性前交叉韧带（ACL）撕裂的治疗方法如何在 5 年内影响炎症和蛋白水解降解的生物标志物。
我们研究了来自随机对照膝关节前交叉韧带、非手术与手术治疗（KANON）试验（临床试验 ISRCTN84752559）的 119 例急性 ACL 损伤患者，这些患者在急性 ACL 撕裂后 5 年内至少有 2 次 6 次就诊时可获得滑液、血清和尿液样本。所有患者均遵循相似的康复方案，根据随机分组，其中 60 例患者接受早期 ACL 重建，59 例患者如果需要，可选择延迟 ACL 重建。通过酶联免疫吸附试验（ELISA）检测白细胞介素（IL）-6、IL-8、IL-10、干扰素-γ（IFNγ）、肿瘤坏死因子（TNF）、氨基酸丙氨酸、精氨酸、甘氨酸、丝氨酸（ARGS）-聚集素、C 端交联肽型 II 胶原（CTX-II）和 N 端交联肽型 I 胶原（NTX-I）。
与随机接受可选延迟重建的患者相比，早期 ACL 重建组患者在索引膝关节滑液中的细胞因子浓度在 4 个月（IL-6、IL-8、IL-10、TNF）、8 个月（IL-6 和 TNF）和 5 年（IFNγ）时更高。在 5 年内接受延迟 ACL 重建的 30 例患者（30 例）5 年时滑液中 IL-6 浓度高于单独康复治疗组。在 5 年内，两组患者的滑液和血清中的 ARGS-聚集素或尿液中的 CTX-II 和 NTX-I 均无差异，无论是随机分组还是治疗分组。
ACL 重建术构成对急性损伤关节的二次创伤，导致已处于高水平的滑液炎症细胞因子水平持续升高。
